Membership Application

Company Name Street Address City Country Phone E-Mail Address State/Prov ZIP/Postal Code Fax Website Title

Membership Categories: Indicate for which category you are applying

Organizational Memberships Corporate Membership Sustaining Membership Individual Memberships Associate Membership Subscribing Membership

Annual dues are $950 for the first year and $850 thereafter Annual dues are $350

Annual dues are $100 for the first year and $75 thereafter Annual dues are $100 for the first year and $45 thereafter

Payment Information
Method of payment: Check/draft in US funds Visa MasterCard American Express _______

Card #

________________________________________ Expiration date

Name on card

____________________________________________________________ _____________________________________________________

Billing address for card

I authorize SPRAT to charge my credit card for the annual dues of the membership category for which I am applying.

Signature

Date

Society of Professional Rope Access Technicians 994 Old Eagle School Road, Suite 1019; Wayne, PA 19087-1866 610-971-4850 (phone) 610-971-4859 (fax) info@sprat.org http://www.sprat.org