EmailMe Form - Associate & Partner Membership

Associate & Partner Membership

The application for Associate Membership in the Association shall be a company whose products or services are allied to the electrical industry. Such company is eligible to apply for an associate membership and shall be accepted upon approval by the Board of Directors. Membership is continuous except in the event of termination by the member or at the will of the Board of Directors. In the case of termination, the use of the Association insignia in any form shall be discontinued immediately. Associate members have the right to attend Association meetings or send approved representation. A $500 must accompany this application.

Select an Option
Associate Member | $500 Annually
Industry Partner - Silver Level | $1300 Annually
Industry Partner - Gold Level | $2800 Annually
Industry Partner - Platinum Level | $4800 Annually
Company name *
Division of:
Company Phone Number *
### - ### - ####
Business Fax
### - ### - ####
General Business Email (i.e. admin@iecfwtc.org) or your main/default email for invoicing, communications, etc. *
This email address will receive all billing notifications.
Business Website *
Business Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region
Would you like to receive emails about IEC FWTC events and news?
Yes
No
Contact Information
Name of Primary Contact *
First Last
Primary Contact Title *
Primary Contact Email *
Primary Contact Business Phone *
### - ### - ####
Primary Contact Business Cell *
### - ### - ####
Primary Contact # of years in trade
Name of Alternate Contact *
First Last
Alternate Title *
Alternate Contact Email *
Alternate Contact Business Phone *
### - ### - ####
Alternate Contact Cell Phone
### - ### - ####
Others who might attend a chapter meeting are:
About Your Work
Main products or services:
Do you have an internal safety program in place?
Yes
No
How did you hear about IEC FWTC membership? Who can we thank for referring you?
Payment Information
Please select your payment type below. All information is securely stored.
Payment Type
Credit Card
Check
Please enter credit card information below, which is stored in a secure location.

For checks, please make checks payable to: IEC
Mail to: 5809 E Berry St., Fort Worth, TX 76119
Payment Amount
$ Dollars . Cents
Credit Card

Card Number

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Completion
I hereby make application for associate membership.

Dues are not deductible as a charitable contribution for federal income tax purposes; however, they may be deductible as an ordinary and necessary business expense. $27.33 of membership dues is allocated for lobbying activities and therefore is non-deductible as a business expense for federal income tax purposes in 2017 (subject to change). [IRC 162(e) and 6033(e)].
Signature
Clear
Text List

Signed by:

Title:

Date:

Signed by:
Title:
Date:

Contact Information

About Your Work

Payment Information

Completion