General Information:
Member Number*
First Name*
MI
Last Name*
Title
Company Name*
Address*
City*
State/Prov*
Zip/Postal Code*
Country*
Country Code and Phone Number*
E-mail address
Country Code and Fax Number*
M
F
Birth Date* Gender*
Business Information:
(Required)
Which ONE of the following best describes your company's type of business?
Which ONE of the following best describes
your primary job function?
Dues:
Your membership dues may be deductible as
an ordinary and necessary business expense, not as a charitable contribution.
Membership
in WAI is held by the individual, not the company, and is continuous unless
cancelled in writing. Membership is not transferable. Dues are billed annually
based upon the member's anniversary date, and are non-refundable. Annual
dues are set by the WAI Board of Directors, and are subject to change.
Chapter Affiliation ($15 - 1st year, $30 - 2 yr membership,
$45 - 3 yr membership)
Please indicate the chapter in which you
would like to participate.
Wire Foundation Contribution (Voluntary)
Invest in the future of the wire and cable industry.
The Wire Foundation is an educational organization exempt from taxation
under the 501(c)(3) code of the Internal Revenue Service. Contributions
to the Wire Foundation may be deductible as charitable contributions
for income tax purposes to the extent provided by law.
As part of my membership, I wish to receive a free subscription
to Wire Journal International .
Father's first name:
(Required field in lieu of signature.)
Choose method of payment:
Credit Card (Please
see note below )
American Express
Diners Club
Master Card
Visa
Card No.
Expires (mm/yy)
NOTE: All credit card transactions
are processed in U.S. dollars. Credit card payments are preferred
for members joining from outside the U.S. and Canada. If
you would rather not provide credit card information online, please
print and fax this form to WAI at (001) 203-453-8384.
Check or Wire Transfers
Please print this application and mail with check
payable to:
The Wire Association International, Inc.
1570 Boston Post Road, P.O. Box 578
Guilford, CT 06437-0578
TOTAL AMOUNT OF CHECK ENCLOSED
US$
For all other countries, if a credit card is not used, send
wire transfer in U.S. dollars
Bank Name: Citizens Bank, Providence, RI, USA
Routing/ABA#: 011500120
FBO: Wire Association International
1570 Boston Post Road
Guilford, CT 06437, USA
Account Number: 2202577739
By clicking on the
button below your information will be forwarded to our membership
department for review. We will respond within one business day
to complete the transaction. Thank you for your business.
**
We recommend that you either mail or fax your membership application
to insure the privacy of your credit card information. Current
electronic transactions ARE NOT SECURED via this web page, please
call with your credit card information during normal business
hours.