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