CCA Carrier/Voting Member Application CCA Carrier/Voting Member Application (Please complete all fields) Your Info Full Name* Title* Email* Enter Email Confirm Email Phone* Company Info Company Name* Company Address* Street Address Address Line 2 City State / Province / Region Zip / Postal Code Afghanistan Albania Algeria American Samoa Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Costa Rica Côte d’Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Sudan, South Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe Country Company Phone* Company Fax* Sponsor Info RCA requires new applicants to have an existing RCA Member sponsor and a letter of reference from that member. Name of Sponsoring Company* Name of Sponsoring Individual* Dues Info For more information on Dues Brackets please visit Carrier Dues Brackets Information Page We will pay our dues based on:* Built-Out POP’s Annual Wireless Revenue POP's Option POP’s From: 0-99,999 POP’s From: 100,000-199,999 POP’s From: 200,000-349,999 POP’s From: 350,000-499,999 POP’s From: 500,000-749,999 POP’s From: 750,000-999,999 POP’s From: 1,000,000-1,249,999 POP’s From: 1,250,000-1,499,999 POP’s From: 1,500,000-1,999,999 POP’s From: 2,000,000-2,999,999 POP’s From: 3,000,000-4,999,999 POP’s From: 5,000,000-7,499,999 POP’s From: 7,500,000-9,999,999 POP’s From: 10,000,000-13,999,999 POP’s From: 14,000,000-up Select Initial Revenue Range Annual Revenue Greater than $10,000 Annual Revenue UNDER $10,000 Select Range of Annual Revenue Revenue From: 10000000-24999999 Revenue From: 25000000-74999999 Revenue From: 75000000-149999999 Revenue From: 150000000-299999999 Revenue From: 300000000-499999999 Revenue From: 500000000-up Enter Actual Annual Revenue This value is used to calculate the dues based on the multiplier selected from the Range of Revenue drop down. Dues based on Annual Revenue Price: $0.00 Revenue under $10,000,000 Price: $1,500.00 automatically assessed minimum dues of $1,500.00 Payment Info Billing Address* Street Address Address Line 2 City State / Province / Region Zip / Postal Code Afghanistan Albania Algeria American Samoa Andorra Angola Antigua and Barbuda Argentina Armenia Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Central African Republic Chad Chile China Colombia Comoros Congo, Democratic Republic of the Congo, Republic of the Costa Rica Côte d’Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Fiji Finland France Gabon Gambia Georgia Germany Ghana Greece Greenland Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Micronesia Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria Norway Northern Mariana Islands Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa Spain Sri Lanka Sudan Sudan, South Suriname Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam Virgin Islands, British Virgin Islands, U.S. Yemen Zambia Zimbabwe Country This page is unsecured. Do not enter a real credit card number. Use this field only for testing purposes. Credit Card* American Express Discover MasterCard Visa Card Number Month 01 02 03 04 05 06 07 08 09 10 11 12 Year 2013 2014 2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 2029 2030 2031 2032 Expiration Date Security Code Cardholder Name Total $0.00 Acceptance (Signature Required)* I Accept Tweet