Download Part 2 - Distribution Contractors Association

DISTRIBUTION CONTRACTORS ASSOCIATION
Member World Federation of
Pipeline Contractors Associations
Membership Requirements
A
of distribution pipelines, cable, and duct systems, and which has
Application for Regular Membership
Firm Name: ________________________________________________________________________________________________
Mailing Address: ____________________________________________________________________________________________
City: _____________________________________________ State: ________________________Zip: ________________________
Physical Address: ___________________________________________________________________________________________
City: _____________________________________________ State: ________________________Zip: ________________________
Telephone: _________________________________________ Fax:___________________________________________________
E-mail: ______________________________________________ Web site: _____________________________________________
If a corporation, list name cers: If individual or partnership, name of owners or partners:
____________________________________________________ _____________________________________________________
____________________________________________________ _____________________________________________________
____________________________________________________ _____________________________________________________
Contact
Name: ______________________________________________ E-mail: ________________________________________________
Title: ________________________________________________ Phone: _______________________________________________
Name: ______________________________________________ E-mail: ________________________________________________
Title: ________________________________________________ Phone: _______________________________________________
Name: ______________________________________________ E-mail: ________________________________________________
Title: ________________________________________________ Phone: _______________________________________________
Number of years in distribution or pipeline construction business: ______________________________________________
Type of Utility: ______________________________________________________________________________________________
Names Please list utility companies and/or municipalities for
which your organization has performed distribution or
_____________________________________________________
pipeline construction during the past three (3) years:
_____________________________________________________
_________________________________Year:____________
_____________________________________________________ _________________________________Year:____________
_____________________________________________________ _________________________________Year:____________
_______________________________________________________ ________________________________________________
Printed name
Company
I have read the DCA Statement of Purpose, and upon
becoming a Regular Member, agree to adhere to its tenets.
__________ _________________________________
Invoice Credit Card Amex MasterCard Visa
CC# _________________________________ ______________
Print and Mail, E-mail or Fax Completed Application to:
Fax: membership
130 dcaweb.org