MEMBERSHIP APPLICATION

Contact Name:

* required

E-mail:

* required

Firm Contact Information

Firm Name:

Street Address:

City:

State:

Zip Code:

Mailing Address:

City:

State:

Zip Code:

Business Phone:

Fax:

Company site:

http://

Firm Business Information

Do you have offices outside of Washington? Yes   No

If yes, please list other locations and indicate corporate HQ.

Principal Field of Activity:

Business Organization Type: Sole Proprietor Cooperative Sub Chapter S Corporation Public Corporation Private Corporation Joint Venture Limited Partnership Limited Liability Company Partnership

WA Certificate #

Year of Firm's formation: 

Firm's Official Voting Representative:

Name: * required

E-mail: * required

Alternate Firm Representatives: (Each firm may name up to three alternate voting representatives)

Name:  Title:   E-mail:

Name: Title:   E-mail:

Name: Title:   E-mail:

Sponsor: Firm:

Average Personnel in all Washington Offices: Note: Average Personnel = FTEs as of 7/1/2008 + current FTEs divided by 2

References:

Approval of Principal:   Date:   Approval

* A $40.00 application fee will be included in the firm's first dues invoice.