Southeastern Insulation Contractors Association P.O. Box 74433, Richmond, Virginia, 23236 804-447-0293 Tel / 865‐584‐8116 Fax email@example.com Application for Membership Please fill in the application. When you are finished, click Save at the bottom. You will then be able to save or print a copy of your application. Application Company Name: Address: City: State: Zip: Phone Fax Website Membership Type Contractor Distributor Manufacturer Manufacturer's Rep Consultant Advertiser Years in Business Type of Work Performed Name Title Phone Email Name Title Phone Email Name Title Phone Email Name Title Phone Email An active SEICA member must sponsor your application for membership. Sponsor Name Sponsor's Company Name Schedule of Dues & Fees for Regular Members (Contractors and Distributors) Initiation Fee Membership Dues Primary Location: $25 $350 Other Locations: $25 $300 Schedule of Dues & Fees for Associate Members (Manufacturers, Agents, Consultants) $25 $600.00 Note: Initiation Fee, is a onetime charge to cover administration of application plus your SEICA plaque.