NAHAD Hose Safety Institute Distributor Member Application

All new Institute Memberships are provisional; compliance with all Institute Membership Requirements must be attained within six months of joining.
Institute Membership fee for the first year includes the Handbook and exams, per company location. $300 per year there after, per company location.
Main Company Name:
Location Co. Name (if different)
Location Address:
City:
State/Province:
Zip/Postal Code:
Country:
Telephone:
Fax:
Location Representative to receive all mailings:
Name:
Title:
Email Address:
Phone:
Location Exam Coordinator:
Name:
Email Address:
Phone:
End Markets Served:
Agricultural Machinery OEM
Agricultural Machinery Aftermarket
Automotive OEM
Automotive Aftermarket
Construction Machinery OEM
Construction Machinery Aftermarket
Food & Beverage
Forestry
General Maintenance, Repair and Operations (MRO)
Government (excluding Military)
Heavy-Duty Truck OEM
Heavy-Duty Truck Aftermarket
Industrial Machinery OEM
Industrial Machinery Aftermarket
Life Sciences (medical, pharma, etc)
Marine
Military
Mining
Oil & Gas
Power Generation
Process
Semicon
Description of services available at this location:
(Hint: Be concise, yet descriptive and compelling. Check spelling before submitting)

Hose Safety Institute Membership Agreement
By becoming a member of the Hose Safety Institute you agree to all Institute Membership Requirements, including ensuring all company employees have access to the Handbook.
Principal's Name:
Date:
Email:
Year One Institute Membership Fee (please check all 3 boxes):
I understand that I am consenting to pay for the joining fee thru 12/31/2018.
$300 per location valid thru 12/31/2018
Handbook
$158 2 Exams (minimum required)
I also understand the fee above covers one location and to have other locations recognized as a Hose Safety Institute I must complete an additional application for each location.
The dues year runs from January 1 – December 31. Dues are renewable by December 31.
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Join the NAHAD Community

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