Vermont Grocers' Association
148 State Street
Montpelier, Vermont 05602
802-839-1928 (office)
802-839-1927 (fax)

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Vermont Grocers Retail Membership Application

Persons, firms or corporations with established places of business, engaged in the retail selling of foods and such other commodities as are usually sold in retail food stores. Please call the VGA office, 1-800-842-8503 if you have any questions. Upon submission, VGA will invoice you for the membership dues as indicated below or you may use the convenient PayPal option.

*Store Name:
*Owner(s) or Contact:

Store Location:

*Street:
*City:		*State:		*Zip:

Mailing Address (*If different from above):

Address:
City:	State:	Zip:

*Bus. Phone:		Home Phone:
Fax:		Email:

Previous Owners:

*Membership Dues - First Store:

$95.00 (less than $250,000 in annual sales)

$125.00 ($.25 to $1.0 million in annual sales)

$185.00 ($1.0-$5.0 million in annual sales)

$250.00 ($5.0 to $15.0 million in annual sales)

$485.00 (Over $15.0 million in annual sales)

Multiple Store Owners (Vermont locations, please proved list):

$25.00 2ND STORE (if only 2 stores owned)

$105.00 (Additional stores with same owner)

Additional Stores:

Other Information:

Gasoline Pumps - No Yes How many?

Number of Check-Out(s)

State Liquor Agency

Certified Redemption Center

Number of Employees: - Full Time Part Time

* Required Fields

Association year runs May 1- April 30.
Your payment carries you from date of joining to the first day of May (2012).

Membership dues to the Vermont Grocers' Association are not deductible under IRS regulations as a charitable donation, however they are generally allowed as ordinary and necessary business expenses subject to the restrictions imposed in the Omnibus Budget Reconciliation Act of 1993 related to lobbying activity. VGA estimates that the portion of your dues allocable to lobbying (and therefore non-deductible) is 36%.