Contact Information
(*Indicates required field) |
| *Company Name: |
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| *Primary Contact Name: |
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| *Title: |
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| *Mailing Address: |
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| *City: |
*State:
*Zip: |
| *Phone: |
Extension:
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| *Fax: |
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| *E-Mail Address: |
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| Web Site: |
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Information about cooperative
nominating membership approval
(*Indicates required field)
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| *Co-op Name: |
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| *Primary Contact Name: |
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| Title: |
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| Mailing Address: |
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| *City: |
*State:
*Zip:
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| Phone: |
Extension:
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| Fax: |
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| Email Address: |
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| Level of Participation: |
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Silver ($1,250)
Gold ($6,500)
Platinum ($12,000) |
| Automatic Renewal: |
| Your company’s membership will automatically
be renewed at the same level each year on the anniversary date of your
membership approval. At that time, you will also have the opportunity
to change your level of membership. |
Product or Service Description:
(30
words or less) |
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| Current tax status: |
Taxable, Incorporated in the state of
Tax-Exempt, Section of the IRS code under which your company is exempt
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Business Category
Select up to four (4) business
categories |
| |
| I understand that in order
to be eligible for Associate Membership in NRECA, my company cannot
itself be engaged in, or be owned or controlled by an entity engaged
in, the generation, transmission, distribution or sale of electricity,
unless that entity is a voting member of NRECA. If my company becomes
engaged in, or becomes owned or controlled by an entity engaged in,
the generation, transmission, distribution or sale of electricity other
than a voting member of NRECA, my company's eligibility for Associate
Membership in NRECA terminates immediately. If my company becomes ineligible
for Associate Membership, any unused Associate Membership benefits remain
the sole property of NRECA.
Associate Membership in NRECA does not signify
an endorsement of products or services. Associate Members shall not
claim or imply that Associate Membership signifies an endorsement by
NRECA of products or services.
Authorized Signature:
Date:
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Method of Payment: |
| Payment by Check |
Check payment for
payable to NRECA.
Print confirmation from email and include it with payment. Send
payment to
Nancy McMahen, NRECA, 2149 S. County Road 137, Bennett, CO 80102.
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| For
additional information, contact Nancy McMahen (800) 230-2601/ nancy.mcmahen@nreca.coop.
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