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Midwestern States Environmental Consultants Association   

MSECA Membership Application

Membership:*

Consultant Member (5 or more Employees* - $450.00)

Consultant Member (3 - 4 Employees* - $300.00)

Consultant Member (1 - 2 Employees* - $175.00)

*For Consultant Memberships, based on the total number of consultant / technician / field employees.

Associate Member (5 or more Employees* - $300.00)

Associate Member (4 or less Employees* - $200.00)

*For Associate Memberships, based on all employees including administrative and sales.

Not sure which category you fall under? Review our Membership & Dues Information for more details.


Directory Information

This is the information that will be used on our MSECA Members Page

Company / Organization:*

Directory Contact Person:

Directory Email Address:

Directory Web Site Address:

Directory Address:

Directory City:

Directory State:

Directory Zip:

Directory Phone:

Directory Fax:


Company Representative (Main Contact)

This will be our main contact for anything involving your MSECA Membership such as membership renewals. It may be the same person as above.

Main Contact's Name:*

Main Contact's Email:*

Main Contact's Phone:


Additional Employees

Additional Emplloyees may be registered to recieve information from MSECA.

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Employee #2 - Name:

Employee #2 - Email:

Employee #2: - Phone:

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Employee #3 - Name:

Employee #3 - Email:

Employee #3: - Phone:

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Employee #4 - Name:

Employee #4 - Email:

Employee #4: - Phone:

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Employee #5 - Name:

Employee #5 - Email:

Employee #5: - Phone:

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Do you have more than 5 Employees you would like to recieve commuinication from MSECA?

Yes

No

If yes, the MSECA Office will follow up with you for their information.


Payment Options*

Check Credit Card (Visa, Mastercard, & Discover)

Email Address to Invoice*

If you select to pay by credit card, an electronic invoice will be sent to the address above from our credit card processor (Authorize.net) with a link to pay securely online.
If you select to pay by check, we'll email you an invoice to return with your payment.


Thank You for Joining MSECA

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