Membership Application

U.S. & Canada

Organizational membership is available to all types of employers, including industries, business associations, federal, state and local governments, nonprofit organizations, schools, universities, colleges and unions.

Please complete all sections of this application, and note that dues are stated and payable in U.S. dollars. You may pay for your membership securely with a credit card, or use our print and fax/mail membership application.

If located outside the U.S. & Canada, please click here to complete the International Application.


Organization/Company Information
Organization/Company Name
Street Address
City
State
Zip/Postal Code
Main Phone
Main Fax
Website (optional)
Total number of full-time Employees (including drivers)
Please check if you
prefer NOT to recieve: 		NSC Electronic/Fax Communications
  Non-NSC Communications
  NSC Listserv Communications
Contact Information
Primary Safety & Health Contact (for benefit Fulfillment)  
Name
Title
Phone
E-mail
Additional Contact  
Name
Title
Phone
E-mail
Organization Location Information
If your membership is to include additional facilities and/or offices other than the location listed above, please indicate the number of additional locations below and we will contact you for further information.
Number of additional locations (facilities and/or offices) included in this Membership
How did you learn about NSC membership?
Publication Selection
Please select one of the following.
OSHA Up To Date Newsletter (via e-mail)
OSHA Up To Date Newsletter (printed)
Traffic Safety Newsletter (via e-mail)
Traffic Safety Newsletter (printed)
For e-mail format: Content is copyright protected and may not be forwarded to other e-mail addresses
Gift Code
To receive your free gift, please enter the gift code from the NSC communication you have received or select one from our online free offers.
Gift Code
You have almost completed your membership application. Please select the credit card type that you wish to use for payment, complete all items and click "Submit Application." Your information will be securely stored, and an e-mail will confirm that your application is received.
Credit Card Information
Credit Card
Credit Card Number
Expiration date (MM/YY)
Name as it appears on card
Dues
Employees Rate (U.S. dollars)
1-10 $250.00
11-49 $285.00
50-99 $315.00
100+ $325.00 + $1.00 per additional employee over 100 (max. $17,000)
Your membership dues will be calculated for you based on the number of employees you entered above.
Questions? Call 1-800-621-7619 or e-mail us at customerservice@nsc.org.

Please...

Please complete all sections of this application.

Note that dues are stated and payable in U.S. dollars. You may pay for your membership securely with a credit card, or use our print and fax/mail membership application.