Fillable 2021 Membership Application Registering (Electrical Association)

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2021 Membership Application Registering (Electrical Association)

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AFFILIATE MEMBERSHIP $85
2021 Membership Application
WHICH MEMBER BENEFITS INTEREST YOU THE MOST?
Aliate Membership is only for employees of member companies. The membership stays with the company.
Employees of member companies enjoy the benets of the Association; however, these individuals choose to have their
own aliate membership to receive the newsletters (e.g., managers of branch locations of member companies).
Newsletters and Government Action Alerts
Lobbying at Legislature
Discounts on Class/Apprentice Training
Networking Opportunities
I am also registering for a class and need a membership discount! If you are registering for a class,
check this box and we will apply the membership discount when we process your total order.
Registering
for a class?
NEW MEMBER INFORMATION:
Yearly Dues: $85
Check enclosed Credit Card (Visa, Mastercard, AmEx)
Credit card #: ________________________________________________________________________________________
Exp. Date: __________ Security Code:__________ Name on Card: _____________________________________________
Enroll in autopay (dues will be drafted from your credit card on le annually)
Billing Address (if dierent than above):
_____________________________________________________________________________
ENCLOSE PAYMENT WITH APPLICATION:
Return your membership application with payment:
MAIL
3100 Humboldt Ave S
Minneapolis, MN 55408
EMAIL
info@
electricalassociation.com
PHONE
612-827-6117
800-829-6117
FAX
612-827-0920
Company: _________________________________________________________________________________
Designated Contact: _________________________________________________________________________
License #: _________________________________________________________________________________
Address: __________________________________________________________________________________
City/State/Zip: ______________________________________________________________________________
Phone: ____________________________________________________________________________________
Fax: ______________________________________________________________________________________
Email: _____________________________________________________________________________________
Web Site: _________________________________________________________________________________
# of Employees: ____________________________________________________________________________
IBEW Merit Shop CLA
Referred by: _______________________________________________________________________________
How did you hear about us? ___________________________________________________________________
Electrical Association members will receive promotional emails on a regular basis for products and services oered to assist their
business needs.
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2021 Membership Application Registering (Electrical Association)

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Completed 17 July 2021

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