CHAIN SUPERMARKET MEMBERSHIP

APPLICATION

Company Name:     ______________________________________

Contact Name:        ______________________________________

Street Address:       ______________________________________

City/State/Zip:         ______________________________________

Telephone:             _______________________________________

Fax:                      _______________________________________

E-Mail:                ________________________________________

For chains with New York sales volume less than $500 million annually, the dues formula is as follows:

Headquarters Fee:     $6,250

Plus $6.50 per $1 million of sales:     ___________

TOTAL DUES:     __________

For chains with New York sales volume exceeding $500 million annually, the dues formula is as follows:

Headquarters Fee:     $6,750

Plus $5.50 per $1 million of sales:     __________

TOTAL DUES:     __________

Please mail your dues, accompanied by this application to our ALBANY office
at
130 Washington Avenue
Albany, New York 12210

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IN ACCORDANCE WITH THE PROVISIONS OF THE OMNIBUS BUDGET RECONCILIATION ACT OF 1993, 77% OF YOUR MEMBERSHIP DUES FOR CALENDAR YEAR 2002 ARE DEDUCTIBLE FOR FEDERAL TAX PURPOSES