SCIA Membership Application 2025

SCIA Membership Application 2025
Thank you for your interest in becoming a member of SCIA (South Central Industrial Association). Please fill out the form below or contact hillary@sciaonline.net or kathy@sciaonline.net for questions.
Company Name*
Number of Employees*
Principal Products or Services*
Website*
Contact Full Name*

First NameLast Name
Position Within the Company*
Phone Number*
Email*
Alternate Contact Full Name

First NameLast Name
Position Within the Company
Alternate Contact Email
Recommended By
Name of Person or Company who Recommended You
Physical Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Mailing Address (Only if different than physical)

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What type of application is this?*
What Membership are you interested in?*
Do you have an employee that would like to participate on a committee?*
Do you have an employee that would like to participate on the NexGen Leadership Coalition*
$100 Investment Per Employee
Feedback you would like to share:
Should be Empty: