Associate Membership Application

The applicant for affiliation in IEC of Southern Arizona shall be a person or corporation who is interested in the electrical industry or desires to encourage the work of this Association. Such a person or corporation is eligible to apply for an Associate membership and shall be accepted upon approval of the Board of Directors. A membership granted will be continuous except in the event of termination by the member or at the will of the Board of Directors. At the time of termination, all dues shall be paid in full as of that date. An Associate Member is bound by the language of the Bylaws that pertains to Associate Membership. Such members will have the right to attend any and all meetings of the Association or to send approved representation.

Membership dues are due January 1st of each year regardless of when you joined. Payment must be submitted with applications. All Major Credit Card or checks are accepted.

Associate Yearly Membership Dues:

$500 Chapter Dues
$96.00 National Dues
A $100.00 initiation fee applies to all applications
All Associate members must belong to IEC National, no exceptions

Applicant Information

* Company Name

* Company Website

* Office Number

Fax If applicable

PRIMARY CONTACT

* Title

* First Name

* Last Name

* Email

* Phone Number Indicate if work or cell

* Date Of Birth

SECONDARY CONTACT

* Title Write N/A if not applicable

* First Name Write N/A if not applicable

* Last Name Write N/A if not applicable

* Email Write N/A if not applicable

* Phone Number Write N/A if not applicable. Indicate if work or cell

* Date of Birth

PHYSICAL ADDRESS

* Address

* City

* State

* Zip

MAILING ADDRESS

if Different

Address

City

State

Zip

* Is the mailing address commercial or residential?

Yes
No

* Main product lines, or brief description of what your company does

* Member Company who recommended IEC of Southern Arizona

* Please type your name in the field below to serve as your signature on this form.