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NAHAD Hose Safety Institute Distributor Member Application Convention Special!

All new Institute Memberships are provisional; compliance with all Institute Membership Requirements must be attained within six months of joining.
Institute Membership fee - $300 per year, per company location 2 MONTHS FREE
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
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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.
Principal's Name:
Date:
Email:
By checking this box I understand that I am consenting to pay a $300 fee for Annual Hose Safety Institute Membership (July 1-June 30). I also understand the $300 fee covers one location and to have other locations recognized as a Hose Safety Institute location I must register them separately:
   - denotes required fields

Hose Safety Institute logo

"Marathon Petroleum Company's Garyville, LA refinery requires that suppliers of utility hoses comply with NAHAD's Assembly Guidelines. NAHAD's commitment to hose assembly safety directly supports Marathon's quality standards."

Roger Gautreau, Safety Supervisor
Marathon Petroleum Company
Louisiana Refining Division