b'MIDWEST INSULATION CONTRACTORS ASSOCIATIONMEMBERSHIP APPLICATION7250 Poe Avenue, Suite 410, Dayton, OH 454141-888-294-0084e-mailmica@micainsulation.orgWebsitemicainsulation.orgName of Company____________________________________________________________________________________Address_____________________________________________________________________________________________(Street)(City)(State)(Zip)Phone Number_____________________________Fax Number _____________________________________________e-Mail Address______________________________________ Website Address ___________________________________Number of Years Company Has Been In Business ____________________________________________________________List those members that you would like listed in the Directory and on the mailing list for MICA publications:Name ___________________________________________Title _______________________________________________Name ___________________________________________Title _______________________________________________Name ___________________________________________Title _______________________________________________Type of Membership: Type of Business:________ Contractor $775 _________ Corporation________ Manufacturer $575 (Own factories that take raw material ________ Partnership and produce products and take title to them ________ Proprietorshisp________ Distributor/Supplier $575 (Buy from manufacturers,lot break, and provide delivery, etc.)________ Fabricator $575 (Take title to products and change their form (add value) by reworking)________ Affiliate $575Contractor Member Information:Union Affiliation[] Identify Local _______________________________________Merit Shop[]Type and Percentage of Work Performed: Insulation;Commercial ________Industrial ________ Abatement ________ Firestop ________100%Please Provide Any Additional Information About Your Company That You Wish to Share:_____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________Note: Annual membership dues are deductible for most members as an ordinary and necessary business expense but ARE NOTdeductible as charitable contributions. MICA is not involved in state or federal lobbying.09/27/2022'