Application For Corporate Gold Level Membership Company Information Corporate Gold Level Annual Dues: $440 — includes 20 members @ $22 each, a Potomac Chapter Website Sponsorship ($75), and a Seminar Coffee Sponsor ($100) Company Name Address City State Zip Phone Fax No. Email Website Employees Participating (Names and Emails) Include the names and emails of up to 20 employees. If members of the National Society, include their membership number. Name E-Mail Business Categories Please list one or two categories that best identify the nature of your business. Category 1 Government (Agency)Blasting / Drilling ContractorsConstruction - GeneralExplosive Sales / DistributionQuarryingEquipment Mfg. Sales, ServiceVibration ConsultantOther If "Other", please specify. Category 2 Government (Agency)Blasting / Drilling ContractorsConstruction - GeneralExplosive Sales / DistributionQuarryingEquipment Mfg. Sales, ServiceVibration ConsultantOther If "Other", please specify. Submit
