Public Agency & Sustaining IMSA Members Only
Add, remove or change information on an employee on your company roster form. One form per person. If you have a large amount (15+) of individuals to add/remove, email membership@imsasafety.org with the full name, email and title of the individuals.
Please complete this form anytime you wish to make changes to your company roster.
You will be notified by IMSA membership team once changes are made to your roster and an invoice is ready in your account to pay.
Please allow 1-2 weeks processing time for your request.
Who is filling this form out?
*
First Name
Last Name
Name of Public Agency/Organization/Business
*
What is your email address?
IMSA Company ID
If known
What is your phone number in case we have questions?
Are you the current Company Administrator?
*
Yes
No
If no, do you want to be made the Company Administrator?
Yes
No
New/Existing Member Information Only
I want to:
*
Please Select
Add a person
Remove a person - not employed any longer
Remove a person - still employed
Remove a person - retired
Remove a person - deceased
Change contact information for a person
Name
*
First Name
Middle Name
Last Name
Suffix
Title
*
Preferred Email Address (Member Only)
*
Work address (if different than your address)
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Work Phone Number
Home Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Personal Email
example@example.com
Comments:
Thank you! We will be back in touch shortly.
Questions, please email membership@imsasafety.org
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