NATEHome.COM: Application Form

Application Form

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Membership Application
Application must be filled out completely to be considered for membership.

*Company Name:

*Primary Contact First Name:

*Primary Contact Last Name:

Secondary Contact Name:

Alternate Contact Name:

Trade Show Contact Name:
(if applicable)

Advertising Contact Name:
(if applicable)

*Billing Contact Name:
(if applicable)

*Mailing Address:

*City:

*State:

*Country:

*Zip:

*Shipping Address:

*City:

*State:

*Country:

*Zip:

*Billing Address:

*City:

*State:

*Country:

*Zip:

*Telephone: (eg: 605-555-1212)

*Fax:

Mobile/2nd Telephone:

Website:

*Email:

I give permission to include my email address on the NATE membership list.
Yes No

*Primary Source of Revenue:

Is your company owned by or a division of another company?
Yes No
*If yes, what is the parent company's name?

What is the parent company's primary source of revenue?*

Does your company currently have major medical coverage?
Yes No

Would your company be interested in supplemental coverage for employees, spouses and families?
Yes No

The following individuals are authorized to purchase NATE Safety & Educational Materials on behalf of the company:
Authorized Person # 1
Authorized Person # 2
Authorized Person # 3
Authorized Person # 4

Our company PERFORMS the following services:
(Please check all that apply to your company)

	Antenna/Line Installation
	Consulting Services
	Engineering Services
	Erect Guyed Towers
	Erect Monopole Towers
	Erect Self-Support Towers
	Foundation Installation
	Helicopter Services
	Inspection Services
	Painting Services
	RF Inspection or Testing Services
	Safety Training Services
	Testing Services
	Turn-Key Construction
Describe other services offered:

Our company MANUFACTURES OR SELLS the following products:
(Please check all that apply to your company)

	Anchor Products & Systems
	Cable/Wire Products & Systems
	Concealment Products
	Fall Protection & Safety Climb Products
	Gin Poles
	Grounding/Lightning Systems
	Guyed Towers
	Hoists/Winches
	Lighting Systems
	Monopole Towers
	RF Related Products
	Rigging Products
	Self Support Towers
	Shelters
	Software Packages
	None of the above
Describe other products offered:

How did you learn about NATE?

	Advertisement
	Which Source?
	Industry Contacts
	Trade Show
	Which Show?
	Internet
	OSHA
	Bidding Contract
	Other
	Please explain:

NOTE: Foreign Member $250 International Handling Fee Required? Yes No

PRIMARY MEMBERSHIP

Type of Company (check all that apply):
Tower Erector
Tower Service
Tower Maintenance
Number of Employees/Annual Dues (Please check one):
Voting Member
1 - 5 ................................ $1,000
6 - 15 ............................... $1,500
16 - 30 ............................. $2,500
31 - 75 ............................. $4,000
76 - 150 ........................... $4,500
151 - 225 ......................... $5,000
226 - 300 ......................... $5,500
301 - 375 ......................... $6,000
376 - 450 ......................... $6,500
451 - 525 ......................... $7,000
Other*
*Primary Voting dues will continue in increments of $500 for each 75 employees above 525.
Non-Voting Member
1 - 30 .............................. $1,500
31 - 75 ............................. $2,000
76 - 150 ........................... $2,250
151 - 225 ......................... $2,500
226 - 300 ......................... $2,750
301 - 375 ......................... $3,000
376 - 450 ......................... $3,250
451 - 525 ......................... $3,500
Other**
**Primary Non-Voting dues will continue in increments of $250 for each 75 employees above 525.

SUPPORT MEMBERSHIP

(Check which apply to your company):

Manufacturer Member
	Gross annual revenue greater than or equal to $10 million = $2,500 annual dues
	Gross annual revenue less than $10 million = $1,250 annual dues
Construction Member
	Gross annual revenue greater than or equal to $10 million = $2,500 annual dues
	Gross annual revenue less than $10 million = $1,250 annual dues
Affiliate Member
	Tower owners or FCC license holders - 25 or more sites = $2,500 annual dues
	Tower owners or FCC license holders - 24 or less sites = $1,250 annual dues
Associate Member
	Gross annual revenue greater than or equal to $10 million = $2,500 annual dues
	Gross annual revenue less than $10 million = $1,250 annual dues

No payment is needed with this application.
You will be invoiced upon membership approval.

Agreement Concerning Confidential Information
We, the undersigned, realize that the National Association of Tower Erectors (NATE) desires to keep various information about its interests and activities confidential and for NATE member companies only, including information pertaining to NATE financial activities, the NATE Accident Prevention, Safety and Health Program Guide, educational videos and other safety awareness materials and media.

We, the undersigned, understand that, as a benefit of NATE membership, we may be furnished with drawings, data sheets, specific safety programs, videos, processes, specifications and financial information, and that we may acquire other such information concerning NATE programs and activities from conversations with NATE officers or personnel, or from our own observations of NATE’s activities. Information disclosed in documentary forms that NATE considers confidential will be marked “confidential” by NATE. In the case of non-documentary disclosures, NATE will have the obligation to confirm in writing the fact and general motive of each disclosure within a reasonable time after the disclosure occurs.

We, the undersigned, understand that a breach of confidentiality could cause harm to NATE, its officers, member companies, and/or personnel and we agree to use every reasonable effort to maintain confidentiality.

We, the undersigned, understand that as a benefit of NATE membership, we are permitted to display the NATE Logo on our company website, letterhead, business cards, and other printed materials. Should our NATE membership end whether by our choice, past due account or termination, we are required to remove the NATE Logo from any printed material or website immediately. We, the undersigned, also understand that this benefit applies to ONLY the company as listed on this application and does not apply to any of our affiliated companies and/or parent company.

It is understood that in the course of fulfilling our business commitments, we may have to communicate some of this information with officers, and/or employees in our company. In the event such information is communicated we will inform them of their responsibility of keeping such information confidential and we will make every reasonable effort to ensure that it is kept confidential.

Information that is obtained by a third party source not under obligation to NATE, or information that is considered is public domain is not confidential. Drawings, data sheets, specific safety programs, videos, written processes, written specifications and financial information remain the property of NATE and must be returned if so requested by NATE.

Project Area: NATE Safety and Educational Materials and NATE Financial Information

Agreed on behalf of

*Company Name:

*Authorized Representative:

* Required Field

NOTE: MEMBERSHIP DUES ARE NON-REFUNDABLE

National Association of Tower Erectors
8 Second Street SE · Watertown, South Dakota 57201-3624
Tel: 605-882-5865 or 888-882-5865 · Fax: 605-886-5184
www.natehome.com · Email: carol@natehome.com