EHS&S Council Join Form

Environment, Health, Safety & Sustainability Council (EHS&S) - Join Form
Thank you for your interest in joining the Environment, Health, Safety & Sustainability (EHS&S) Council. Please complete the following form to apply for council membership. All submissions are subject to approval.

Please accept my request to join the MEMA Orginal Equipment Suppliers EH&S Council. I recognize that council participation is conditional on my company’s continued good standing as a MEMA Orginal Equipment Suppliers member. I agree to pay a $1,050 annual fee for my participation and will name an alternate to attend in my absence.
Main Council Participant*

First NameLast Name
Title:*
Ex: VP of sales
Email:*
Contact Number:

Area CodePhone Number
Yes, I would like to be included in the council directory.No, I DO NOT want to be included in the council directory.
Alternate Council Participant:

First NameLast Name
Title:
Ex: VP of sales
Email:
Contact Number:

Area CodePhone Number
Yes, I have received authorization from my alternate to include them in the council directory.No, I DO NOT want the alternate to be included in the council directory.No alternate is designated at this time.
Company Name:
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry
Contact me for credit card informationInvoice me
Comments or Requests:
Should be Empty:

Environment, Health, Safety & Sustainability Council (EHS&S) - Join Form