b'CSIA MEMBERSHIP CSIA 31CENTRAL STATES INSULATION ASSOCIATION MEMBERSHIP APPLICATION APPLICANT INFORMATION Company Name: _______________________________________________________________________ Address: ______________________________________________________________________________ City, State & Zip: _______________________________________________________________________ Telephone: ___________________________________Fax: __________________________________ Contact Name: _________________________________________________________________________ Email: _______________________________________Website: _______________________________ TYPE OF MEMBERSHIP REQUESTED (check only one )Contractor $425.00 InsulationAbatementUnionizedMerit Distributor/Fabricator $425.00Associate $513.00 ManufacturerSales Manufacturing Representative Engineer/Specifier $95.00APPLICANT INFORMATIONPlease Answer the following questions so that we may get to know you better, and feel free to use additional sheets as necessary . 1. Type of Work in which your company is engaged: ___________________________________________2. Length of time company has been in business; date established: _______________________________3. Primary geographic area of operation: ____________________________________________________4. Brief history of company: ________________________________________________________________________________________________________________________________________________5. Identify Principals of Company and Titles: ___________________________________________________________________________________________________________________________________6. Number of Employees: ________________________________________________________________7. Labor Organizations representing your employees: __________________________________________8. Is your company a member of NIA? YesNoThis application for membership is made subject to the Bylaws governing such membership.It is understood and agreed that, if and when approved by the associations Board of Directors, the applicant shall maintain membership in good standing and shall terminate it only in writing, and only after all obligations to the association have been met.The undersigned company and itsrepresentatives agree to abide by all terms and conditions of the associations bylaws. Membership Proposed by: ________________________________________________________________ Existing CSIA Member Signature of Applicant: _____________________________________Date: ______________________ Make dues check payable to CSIA and return with application.Payment via Visa, MasterCard, Discover and American Express are also accepted. Card Number _______________________________________________Expiration Date ______________________ Name on Card ______________________________Authorized Signature _________________________________ Send back completed form and payment to: FAX: (937) 278-0317 or MAIL: 7250 Poe Avenue, Suite 410 - Dayton, Ohio 45414 csiaonline.org'