CSA Membership Application

Membership Application

Annual Dues
$1,000 for DAS pre-qualified subcontractors
$500 for non DAS pre-qualified subcontractors

New members can deduct 10% from the annual dues.

Company

Address*

City

State * Zip *

Phone

Website Address

Primary Contact Name

Primary Contact Title

Primary Contact Email

Primary Contact Cell Phone

Secondary Contact Name

Secondary Contact Title

Secondary Contact Email

Secondary Contact Cell Phone

What is your reason for joining CSA? Please check all that apply.

Access, Information and Mentoring	Education	Legislative Protection and Information
Newsletter	Discounts	Membership Directory
Networking	Problem Getting Paid

Who referred you to CSA? Name | Company

Do you have a colleague to recommend for CSA membership?

Name | Company | Email

Please check your primary trade. Please check all that apply.

If other please describe

We agree to abide by and comply with all rules and regulations contained in the CSA bylaws.

Payment

Total

Credit Card* Master Card Visa AMEX

First Name

Last Name* Email *

Credit Card #

Expiration Month *Expiration Year *Security Code*

CSA dues are not deductible as a charitable contribution for federal tax purposes, but may be deductible as a business expense up to 81%.

CSA | 1131-O Tolland Turnpike, # 272 | Manchester, CT 06042-1679 Phone: (866) 995-3919 www.connecticutsubcontractors.org | katie@connecticutsubcontractors.org