Please remember to click on "Submit" at the bottom of this form to complete your online registration process

Membership Category

	Wholesaler
	I affirm that over 50% of our gross profits are consistently derived from wholesale trade accounts which do not include builders, contractors, or site applicators.
	Manufacturer
	Service Affiliate
	Divisional Member
	Branch Member
	(Parent Company)

Please submit a two-sentence description of your company (mandatory):

Company
Contact
Title
Street Address
City
State/Prov
Zip/Postal Code
Number of Employees
Phone
Fax
Email
Website

All membership applications MUST be endorsed by two current NAWLA members. At least one endorser must be a wholesaler. One of the two endorsers should operate within your immediate geographic region. Please specify below the companies and contacts that you would like to have endorse your application. (Note: Service Affiliate applicants need only one wholesaler endorser.)

Endorser 1:
Company
Contact
Endorser 2:
Company
Contact

Dues Table
(Rates are effective until 03/31/2011)

Please select the appropriate sales volume and corresponding dues amount below. Sales volumes are kept strictly confidential.

Wholesalers
Dues are based on dollar amount ($US) of annual sales

Under $2.5 million	$ 995 per year
$2.5 - $6 million	$1,660 per year
$6.1 - $10 million	$1,865 per year
$10.1 - $25 million	$1,930 per year
$25.1 - $50 million	$2,070 per year
Over $50 million	$2,285 per year

Manufacturers
Dues are based on dollar amount ($US) of annual sales

Under $15 million	$695 per year
$15 - $50 million	$895 per year
$50.1 - $100 million	$1,190 per year
Over $100 million	$1,385 per year

Service Affiliates

All Service Affiliates

$865 per year

Divisional Membership

All Divisions

$1/2x per year

Divisional members must be of the same membership category as the parent company, but can use a different company name. Dues are one-half the rate of the parent company and includes all benefits of the primary membership.

Branch Membership

All Branches

$330 per year

Branch members must be of the same membership category as the parent company and must use the same company name. Provides all mailings to this additional location of the parent company.