Affiliate Membership Application

Affiliate Membership Application

Emergency Road Service Coalition of America
Affiliate Membership is annual, effective on the date of your application and payment is received, renewals are billed on your anniversary date.

Membership = $300.00
SAFETY THROUGH TRAINING & ADVOCACY
An ERSCA Affiliate Member is defined as being a towing company that has no physical location within the State of California but would like to take advantage of the ERSCA benefit programs. ERSCA Affiliate Members are a non-voting member however qualify for discounts provided through the ERSCA Essentials training events along with benefits offered by our National Partners and Training Supporters. All Affiliate Memberships are ultimately contingent upon initial Board approval and ongoing compliance with ERSCA bylaws and policies. The Affiliate Membership fee is annual, starting on the day your application and payment is received by ERSCA.
Becoming a Affiliate Member

By becoming an Affiliate Member, you agree to abide by the Bylaws & policies of the Emergency Road Service Coalition of America. All Affiliate Memberships are ultimately contingent upon initial Board approval. Until such approval, the applicant shall be designated as a Provisional Affiliate Member. If not approved by the Board, a prorated portion of the fee will be refunded. Any Affiliate Membership can be terminated immediately, without a refund of fees, if the ERSCA Board determines that a Affiliate Member violated ERSCA Bylaws & policies, including engaging in conduct deemed by the Board to be materially and seriously prejudicial to the purposes and interests of the Association. Membership is annual, effective on the date your application and payment are received, renewals are billed on your anniversary date. Contributions or dues paid to the Emergency Road Service Coalition of America are NOT TAX DEDUCTABLE AS CHARITABLE CONTRIBUTIONS. However, you may deduct the expenses as ordinary and necessary business expenses. Please consult a tax professional for further information.

Your Contact Information
Please let us know how you would and would not like to be contacted. Unless otherwise noted on this application form, your contact information is shared with other ERSCA Industry Partners and Supporters through our electronic directory. Contact the ERSCA office at (916) 617-2882 or staff@ersca.org if there is any information you do not wish to share.

By joining the Emergency Road Service Coalition you automatically “opt-in” to our electronic communications such as the e-Newsletter, Training Updates, News Bulletins, and various other notifications. At any time you may opt-out through the “unsubscribe” link at the bottom of these e-mails.

Communications & Third Party Links
At our discretion, we may occasionally include or offer third party products or services on our website and in our communications. These third party sites have separate and independent privacy policies. Therefore, we have no responsibility or liability for the content and activities of these linked sites. Nonetheless, we seek to protect the integrity of our site and welcome any feedback about these sites.

Company Name*
Legal Business Name
Mailing Address*

Street Address

Street Address Line 2

CityState

Zip Code
Physical Address (if different)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Business Phone*
Business Fax
Please enter a valid phone number.
Business Website
Primary Contact*
Primary Contact Phone Number*
Please enter a valid phone number.
Primary Contact Email*
example@example.com
Total Fleet Size (number)*
Fleet Information

Service TrucksLight Duty TrucksMedium Duty TrucksHeavy Duty TrucksRotator UnitHeavy Duty Equipment Trailer (Landol, Lowboy, etc.)
USDOT #*

By signing below, you acknowledge that you have read and understand the above policies & information. Further, you acknowledge that Affiliate Members, per Bylaw section 4.3, do not have voting rights and all Affiliate Memberships are ultimately contingent upon initial Board approval and are subject to ongoing compliance with the ERSCA bylaws and policies.
Signature*

Clear
Date*

MonthDayYear
Date

My Products*

ERSCA Affiliate Membership

$300.00

Total

$0.00

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Emergency Road Service Coalition of America

643 West Stadium Lane

Sacramento, CA 95834

916-617-2882 www.ersca.org
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