Dues Schedule (Use for Section 3)
annual Dues initiation Fee total
Manufacturer ...................................................... $825 ............................................... $200 ............................................. $1025
Distributor/Dealer ............................................... $285 ............................................... $100 ............................................... $385
Contractor/Integrator ......................................... $285 ............................................... $100 ............................................... $385
Manufacturer’s Representative ............................ $285 ............................................... $100 ............................................... $385
Full Associate Member ........................................ $285 ............................................... $100 ............................................... $385
Energy Management Company .......................... $200 ............................................... $100 ............................................... $300
Regular Associate Member .................................. $200 ............................................... $100 ............................................... $300
Retiree Member ....................................Complimentary ................................................... $0 ................................................... $0
Student Member ..................................Complimentary ................................................... $0 ................................................... $0
notE: A FULL 12-MONTH DUES PAYMENT MUST BE RECEIVED WITH THIS APPLICATION. The Association’s Membership Year is January 1
through December 31. Dues payments that extend beyond the first Membership Year will be applied to the second year’s dues.
Full paymEnt muSt bE rEcEiVED With application.
3. membership Dues (Please fill in the appropriate TOTAL
amount from the above dues schedule.)
Membership Dues $___________
Membership Plaque (optional)** $___________
On-Site Power Reference Book (optional)** $___________
Florida residents: Add 6.5% Sales Tax to items $___________
Continental US Residents add $5 shipping/handing to**items. $___________
Non Continental US Residents should call EGSA
Headquarters for shipping charges for **items. total $___________
49. 95**
125.00**
4. payment method (Payable in US$ drawn on U.S. bank,
U.S. Money Order, or American Express)
❏ Check #______________ Amount Due ____________
❏ Money Order
❏ Mastercard ❏ Visa ❏ American Express
Card _______________________________ Exp. Date _______
Signature: _____________________________________________
Print Name: ___________________________________________
5. products/Services Please describe the nature of your business ( 50 words or less, NOT ALL CAPS). If you are a Manufacturer’s Representative or
Distributor/Dealer, please indicate which manufacturers you represent and/or distribute for; if you are a student, please provide the name and location of your
school, your major and your anticipated graduation date:
Do you buy AND sell equipment? ❏ Yes ❏ No Do you manufacture packaged equipment? ❏ Yes ❏ No
available codes:
01 ---Batteries/Battery Chargers
02 ---Control/Annunciator Systems
29 ---Education
30 ---Emission Control Equipment
04 ---Enclosures, Generator Set
05 ---Engines, Diesel or Gas
06 ---Engines, Gas Turbine
07 ---Engine Starters/Starting Aids
08 ---Filters, Lube Oil, Fuel or Air
28 ---Fuel Cells
03 ---Fuel Tanks and Fuel Storage Systems
09 ---Generator Laminations
10 ---Generator Sets
11 ---Generators/Alternators
12 ---Governors
13 ---Heat Recovery Systems
14 ---Instruments and controls, including meters,
gauges, relays, contactors, or switches
15 ---Load Banks
16 ---Motor Generator Sets
17 ---Radiator/Heat Exchangers
18 ---Relays, Protective or Synchronizing
19 ---Silencers/Exhaust Systems/Noise Abatement
20 ---Solenoids
21 ---Swtichgear and Transfer Switches (
Automatic or Manual), Bypass Isolation Switches,
and/or Switchgear Panels
22 --- Trailers, Generator Set
23 --- Transformers
24 ---Uninterruptible Power Supplies
25 ---Vibration Isolators
26 ---Voltage Regulators
27 --- Wiring Devices or Receptacles
Enter codes here:
products sold: __________________
_________________________________
products rented: _______________
_________________________________
products serviced: ______________
_________________________________
6. Sponsor(s): A”Sponsor” is an EGSA Member who interested you in filling out this application. It is not mandatory that you have a sponsor for the
Board to act favorably on this application; however, if a Member recommended that you consider membership, we request that individual’s name and company name for our records.
Sponsor Name ______________________________________________Company Name _______________________________________________________________
7. official representative’s authorization
