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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.

Save time and money in maintaining your membership! Make sure to take advantage of the multi-year membership and save 10% on a two- year membership and 15% on the three- year membership.
Number of Employees 1 Year Membership 2 Year Membership 3 Year Membership
1-10 $350 $630 $890
11-49 $375 $675 $955
50-99 $395 $710 $1005
100+ $495 + $1 per employee over 100 $890 +$2 per employee over 100 $1260 +$3 per employee over 100
Your membership dues will be calculated for you based on the number of employees you enter below.
Organization/Company Information
Organization/Company Name*:
Address 1*:
Address 2:
City*:
State*:
Zip/Postal Code*:
P.O. Box:
Main Phone*: - -  
Main Fax: - -
Website: (optional)
Membership Tenure*:  
Total number of full-time Employees (including drivers)*: Used for Calculating dues level   
Please check if you
prefer NOT to receive:
Contact Information
Primary Safety & Health Contact (For Benefit Fulfillment)
Name*:
Title*:
Phone*: - -  
E-mail*:
Executive Management Contact
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?:
Gift Code
To receive your free gift, please enter the gift code from 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
Payment Due: $0
Credit Card Type*:  
Credit Card Number*:
Expiration date (MM/YY)*:  
 
Name as it appears on card*:
CVV*:
Questions? Call 1-800-621-7619 or e-mail us at customerservice@nsc.org.
 
   
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