Affiliate Membership Registration - Application Payment

The NAHAD Membership Committee has approved your application for affiliate membership. The only remaining step required is to complete and submit this online Membership Registration.
Company Name:
The key contact will receive all mailings and invoices:
Key Contact Name:
Key Contact Title:
Key Contact Email:
So that we may serve you better, please provide the following employee contact information.
1. Employee Name:
1. Title:
1. Email:
2. Employee Name:
2. Title:
2. Email:
3. Employee Name:
3. Title:
3. Email:
4. Employee Name:
4. Title:
4. Email:
5. Employee Name:
5. Title:
5. Email:
Company branches listed below, for which the annual service fee is paid, will receive all NAHAD mailings and communications, and will be published in the Annual Membership Directory and listed on the NAHAD website.
Branch Name:
Address:
City:
State:
Zip/Zone:
The dues year runs from Jan - December 31
By checking the box you are agreeing to pay $1050
Branch Fee for additional locations $150per location
   - denotes required fields

Join the NAHAD Community

Become a part of the community dedicated to growth and prosperity in the hose and hose accessory industry.