Associate Membership Application

ACA/NE Associate Membership Application Form

MEMBERSHIP INFORMATION:

Company

Street/P.O. Box*

City

State*Zip Code*

Website

Phone* Fax

Key Contact

Title

Cell

Second Contact

Title

Cell

How did you find out about ACA/NE?

MEMBERSHIP DEMOGRAPHICS AND PAYMENT:

Corporate Members: Distributor, Wholesaler, or Manufacturer’s Rep

Associate Members: Private career school, or any person, firm, partnership, company or corporation that provides a non-HVAC related service to HVAC contractors. Examples include accountants, lawyers, insurance companies.

Check One:

Corporate = $1,000	Associate = $400
Vocational School or Instructor = $100	Student - $50

Total Fees

Payment* Master Card VISA American Express

Credit Card #

Security Code* Expiration Month* Expiration Year*

First Name

Last Name * Email*

Billing Zip Code

ACANE dues are not deductible as a charitable contribution for federal tax purposes, but may be deductible as a business expense up to 62%.