Corporate Gold Level Annual Dues are $440 which includes 20 members @ $22 each plus a Potomac Chapter Website Sponsorship valued at $75 and also a Seminar Coffee Sponsor valued at $100
Company Name
Address
City State Zip
Phone Fax No.
Email Website
Include the Names of Employees who will participate in the Chapter activities. If they are members of the National Society, include their membership number.
Employee Names
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
Employee Emails
Please list one or two categories that best identify the nature of your business
1. -- Please Choose One -- Government (Agency) Blasting / Drilling Contractors Construction - General Explosives Sales / Distribution Quarrying Equipment Mfg. Sales, Service Vibration Consultant Other
2. -- Please Choose One -- Government (Agency) Blasting / Drilling Contractors Construction - General Explosives Sales / Distribution Quarrying Equipment Mfg. Sales, Service Vibration Consultant Other