National Membership Application

NATIONAL MEMBERSHIP APPLICATION

Required for each chapter submission to Western Colorado IEC Chapter.
COMPANY NAME*
Name of Your Company
WEBSITE*
https://www.yourcompany.com
PRIMARY CONTACT NAME*

First NameLast Name
EMAIL*
example@example.com
COMPANY PHONE*
Please enter a valid phone number.
MOBILE PHONE*
Please enter a valid phone number.
FAX NUMBER
Please enter a valid phone number.
SECONDARY CONTACT NAME

First NameLast Name
EMAIL
example@example.com
COMPANY PHONE
Please enter a valid phone number.
MOBILE PHONE
Please enter a valid phone number.
FAX NUMBER
Please enter a valid phone number.
TYPE OF MAILING ADDRESS*
CHAPTER NAME*
MAILING ADDRESS*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
PHYSICAL ADDRESS (if different)

Street Address

Street Address Line 2

CityState

Zip CodeCountry

CONTRACTOR & ASSOCIATE MEMBER DUES

Payment of dues for at least the first quarter of membership is required with each application. Applications cannot be processed without payment. Gold, Silver & Bronze levels are required.
TYPE OF NATIONAL MEMBERSHIP*
QUARTERLY/YEARLY CONTRACTOR FEE TABLE
ASSOCIATE MEMBER DUES*
CONTRACTOR MEMBER DUES*
See Quarterly/Yearly Contractor Fee Table below
PAYMENT OPTIONS

MEMBERSHIP PAYMENTS

Dues payments, contributions and gifts to IES National ARE NOT tax deductible. As charitable contributions for federal income tax purposes; however, they may be deductible as ordinary and necessary business expenses. 27.5% of national membership investment is allocated for lobbying activities and therefore is noon-deductible as a business expense for federal income tax purposes in 2021. (Subject to change.) [IRC 1 62(e) and 6033(e)]. IES accepts members regardless of race, creed, sex, color, physical disability and national or ethnic origin.
PAYMENT POSTING DATES
PRINTED NAME*
By entering your name here you are approving this submission
DIGITAL SIGNATURE

Clear
DATE*

MonthDayYear
Date
PLEASE VERIFY YOU ARE HUMAN*
Should be Empty:

NATIONAL MEMBERSHIP APPLICATION