Associate Member Application

If you’d prefer to print this form and mail it to us with a check, click here.

The fees associated with the membership are:

  • Alliance partner – $1,000
  • Manufacture, distributor or retailer with 5 or more locations – $500
  • Retailer or Distributor (4 locations or less) – $200
Company Name
Address Line 1
Address Line 2

City

State

Zipcode

Website Address

E-mail

Work Phone (xxx-xxx-xxxx)

Fax Number (xxx-xxx-xxxx)

Primary Contact Name

What type of business is your organization?
Manufacturer
Retailer
Distributor
Tech Member
Inspector
Industry Associate