A Non-Profit Organization dedicated to serving Independent Shoe Retailers nationwide

Your Company Name:

Website:

Mr

Mrs

Ms

First Name:

Last Name:

Address:

City /State /Zip:

Phone:

Fax:

Email:

Your Job Title:

Owner

President

Vice President

Store Manager

General/District Manager

Buyer

Merchandise Manager

Other, please specify:

MEMBERSHIP $95
per Membership Year -- Membership year 10/1-9/30

Total:

Method of Payment:

Check payable to: USRA
Mail check payment to:
USRA Membership Dept
PO Box 4931
West Hills, CA  91308

PayPal

Mastercard

Visa

Credit Card #:

Expiration Date:

Recurring Billing – 30 Day Notice