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FILL OUT AND RETURN THIS MEMBERSHIP APPLICATION WITH APPROPRIATE DUES.

Send completed application form and appropriate dues to: Granite State Designers and Installers Association 53 Regional Drive, Suite 1, Concord, NH 03301-3520

Please register me as a member of the Granite State Designers and Installers Association in the
following membership category:

_____ Active Member

_____ Associate Member

NOTE: Must indicate who within your organization has previously paid the active member rate: _________________________________________________________________

_____ Affiliate Member

_____ Public Sector member

NOTE: Applicants must provide their governmental agency, and position within that agency: ______________________________________________________________________

NAME___________________________________________________________

TITLE____________________________________________

AFFILIATION (firm or agency)________________________________________________________________________

MAILING ADDRESS______________________________________________________________________

CITY/STATE/ZIP________________________________________________________________

TEL. NO._______________________________________________

FAX______________________________________________________

E-MAIL ADDRESS__________________________________________

LICENSE NUMBER(S) AS APPLICABLE: DESIGNER (D):______________

INSTALLER (I): _______________

PUMPER:____________

PRORATA DUES FOR THOSE JOINING AS "ACTIVE MEMBERS" DURING THE YEAR
Proration schedule applies to active member category only
JOINING BETWEEN JANUARY 1 AND MARCH 31: Full current fiscal year's dues are payable.
JOINING BETWEEN APRIL 1 AND JUNE 30: 75 percent of current year's dues are payable.
JOINING BETWEEN JULY 1 AND SEPTEMBER 30: 50 percent of current year's dues are payable.
JOINING BETWEEN OCTOBER 1 AND DECEMBER 31: Pay full current year's dues. Payment will qualify organization to receive balance of calendar year, and full upcoming calendar year for this single fee.