Associate Membership Application
2015 ASSOCIATE MEMBERSHIP APPLICATION Energy Council of the Northeast PO Box 1029 Windham, NH 03087 DUES: The annual dues for 2015 Associate Membership is $475/calendar year (January – December) for the first membership and $240 per year for additional members from the same company. BUSINESS INFORMATION: (Please complete individual applications for each additional membership requested). NAME: ____________________________________________________________________________________________________ JOB TITLE: _________________________________________________________________________________________________ COMPANY: ________________________________________________________________________________________________ ADDRESS: _________________________________________________________________________________________________ CITY: _________________________________________ STATE: ___________________
ZIP CODE: ______________________
WEB SITE: __________________________________________ E MAIL ADDRESS: ____________________________________ TELEPHONE #: _______________________________________ FAX #: _____________________________________________ Is the above business information listed the way you would like to present your company in our Member Directory? If not, please list the information on the reverse.
Please mark the category that best describes your company: Architectural/Engineering Contractor Manufacturers’ Representative Business Management Distributor Supplier Consultant Manufacturer Other: _______________________________________________________________________________ To properly classify your company in our Member Directory, please expand upon your company's description in a 45-100 words. We will use this information in our directory and for your member listing on our web site. Feel free to submit this on another sheet of paper. ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Please see next page
Company Advertisement: As an Associate Member, ECNE includes your FULL COLOR ad, (8 ½ x 11 inches) in our Membership Directory. There is NO ADDITIONAL FEE for this service! Please submit your company advertisement to [email protected]. We accept jpg or tif picture files, pdf or any file created in MS Office Suite (word, power point, etc.)
If you would like different contact information printed in the directory and listed on the web site (other than your contact info from the front), please include it here: COMPANY: ________________________________________________________________________________________________ ADDRESS: _________________________________________________________________________________________________ CITY: _____________________________________
STATE: ____________________
TELEPHONE #: ________________________________
ZIPCODE: _______________________
FAX #: ________________________________
I hereby apply for Associate Membership within the Energy Council of the Northeast and enclose payment to cover each assessment of dues as stated above. Signature: ____________________________________________________
Date: _____ / _____ / _____
Please return this application with a check made payable to the ENERGY COUNCIL OF THE NORTHEAST. If you prefer, ECNE can charge your membership and mail you a receipt. To comply with data security regulations, we no longer accept credit card information via email or fax. To pay by credit card, please phone our office and we will process your card while on the phone with you. A receipt will be sent to you automatically by Authorize.net. Mailing info: Energy Council of the Northeast PO Box 1029 Windham, NH 03087 or email this application to Sarah Elise Klingler at [email protected]
ZIP CODE: ______________________
WEB SITE: __________________________________________ E MAIL ADDRESS: ____________________________________ TELEPHONE #: _______________________________________ FAX #: _____________________________________________ Is the above business information listed the way you would like to present your company in our Member Directory? If not, please list the information on the reverse.
Please mark the category that best describes your company: Architectural/Engineering Contractor Manufacturers’ Representative Business Management Distributor Supplier Consultant Manufacturer Other: _______________________________________________________________________________ To properly classify your company in our Member Directory, please expand upon your company's description in a 45-100 words. We will use this information in our directory and for your member listing on our web site. Feel free to submit this on another sheet of paper. ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ ________________________________________________________________________________________ Please see next page
Company Advertisement: As an Associate Member, ECNE includes your FULL COLOR ad, (8 ½ x 11 inches) in our Membership Directory. There is NO ADDITIONAL FEE for this service! Please submit your company advertisement to [email protected]. We accept jpg or tif picture files, pdf or any file created in MS Office Suite (word, power point, etc.)
If you would like different contact information printed in the directory and listed on the web site (other than your contact info from the front), please include it here: COMPANY: ________________________________________________________________________________________________ ADDRESS: _________________________________________________________________________________________________ CITY: _____________________________________
STATE: ____________________
TELEPHONE #: ________________________________
ZIPCODE: _______________________
FAX #: ________________________________
I hereby apply for Associate Membership within the Energy Council of the Northeast and enclose payment to cover each assessment of dues as stated above. Signature: ____________________________________________________
Date: _____ / _____ / _____
Please return this application with a check made payable to the ENERGY COUNCIL OF THE NORTHEAST. If you prefer, ECNE can charge your membership and mail you a receipt. To comply with data security regulations, we no longer accept credit card information via email or fax. To pay by credit card, please phone our office and we will process your card while on the phone with you. A receipt will be sent to you automatically by Authorize.net. Mailing info: Energy Council of the Northeast PO Box 1029 Windham, NH 03087 or email this application to Sarah Elise Klingler at [email protected]
