Organizational Membership CFO Enrollment Form

Transcription

1 Organizational Membership CFO Enrollment Form SSPC: The Society for Protective Coatings Page 1 of 5 Choose Your Membership Level Flex Points Patron CFO Member ($800 Annual dues) Points Sustaining CFO Member ($1,800 Annual dues) Points Your membership will start the same day your dues payment arrives at SSPC. Don t delay, sign up with a credit card or a company check today! Information Name Mailing Phone Contact Name Web Payment Information Fax CREDIT CD **Fax credit card orders to American Express MasterCard Visa Discover Account Number Expiration Date Cardholder Name Signature Credit Card Security Code 1. What Does Your Facility Do? A. Chemical Processing B. Petroleum Refining C. Metals and Mining D. Pulp & Paper E. Oil or Gas Production F. Conventional Power G. Nuclear Power H. Rail Mfr. & Repair I. Bridge & Highway J. Shipyard K. Waterfront, Locks, Dams L. Water Works M. Waste Treatment O. Food/Pharmaceutical P. Equipment/Vehicle Mfr./ Maintenance Q. Pipeline R. Gas Utility S. Unknown Y. Other Questions? Call Member Services Phone: Toll Free: or send to membership@sspc.org CHECK ENCLOSED **Mail check + form to: SSPC P.O. Box Pittsburgh, PA Tell us about your organization or agency Please provide a brief description of your organization for the JPCL and SSPC.org. SAVE TIME! Join by phone and we ll do the paperwork for you!

2 Name Your Official Representative and Alternate Representative Page 2 of 5 Your Official and Alternate Representatives will be your liaisons to SSPC. They will receive full member privileges as outlined on Page 3 of this form. Please complete and return this enrollment form with dues payment. Official Rep Alternate Rep Demographics Please mark the appropriate box to indicate the demographics that apply to the Official Rep () and the Alternate Rep (). 1. Primary business in terms of coatings work? (Check just ONE please) A. Facility Owner / End User of Coatings B. Architect / Engineer / Consultant C. Contractor m a. Painting m b. Flooring m c. General m d. Specialty m e. Concrete m f. Other D. Shipyard E. Fabricator F. Manufacturer m a. Abrasives m b. Equipment for coatings work m c. Coatings and linings m d. Coatings raw materials m e. Other G. Dealer/Distributor/Store H. Government, Regulatory Agency, Research Y. Other (Specify) 2. In which industries or structures are you involved in coatings work? (Select all that apply.) A. Chemical processing B. Petroleum refining/processing/ distribution C. Metals and mining D. Pulp and paper E. Oil/gas production F. Power, conventional G. Power, nuclear H. Bridge and highway I. Waterfront/locks/dams J. Water works/storage K. Waste treatment L. Food, beverage or pharmaceutical M. Pipeline N. Gas utility O. Shipping/ship management P. Railcar manufacturing and/or repair Q. Equipment/vehicle maufacturing and maintenance R. Military S. Stadiums & theme parks T. General Commercial Y. Other 3. Which products and services do you purchase or specify? (Select all that apply.) A. Coatings for steel B. Coatings or materials to protect concrete C. Surface preparation equipment and materials D. Coatings application equipment E. Coatings inspection equipment F. Safety equipment G. Containment H. Access and scaffolding equipment I. Lab and field testing equipment J. Coatings raw materials K. Painting services L. Consulting or engineering services Y. Other

3 Add Designated s to Roster (No Flex Points Needed!) In addition to Official and Alternate representatives, your membership automatically includes the following number of additional roster spots without using Flex Points. These individuals will receive full SSPC individual membership benefits: - Patron Members: 3 extra individual members - Sustaining Member: 5 extra individual members Page 3 of Patron & Sustaining Designated Roster Spots (+3) Additional Sustaining Designated Roster Spots (+5) Work Codes: For each member, enter codes as needed. You may use more than one. a. Applicator/Painter b. Blaster/Surface Preparation c. Environmental Compliance d. Executive Management e. Industrial Hygiene f. Project Manager g. Purchase or Specify Coatings h. Purchase/Specify Equipment/Abrasive i. Quality Control (Inspector, Specialist) j. Regulator k. Sales/Marketing l. Technical Services (Consultant, Engineer) m. Testing, Research, Formulation n. Unknown o. Other Individual Member Benefits: Each individual included on your membership roster will be entitled to the following benefits: FREE Standards Downloads-Unlimited 24/7 access to SSPC standards at SSPC.org FREE JPCL Subscription Get on The List -Be found by people who need your expertise! All members get detailed listings in the online Member Directory (includes certifications). Discounts-30% on most SSPC publications, 10% on most videos, and up to $200 in savings on training courses and certifications. SSPC Insider Content-Login to SSPC.org for access to exclusive member content. JPCL Magazine Search-Access to PaintSquare s JPCL Search. Technical Help- Ask SSPC is SSPC s unique technical concierge available to answer your coatings questions. Voting Rights-Eligibility to vote in SSPC Board of Governors elections. Committees-Eligibility to participate on technical committees and help write standards. Networking-Network via SSPC Local Chapters, CoatingsTalk listserve, LinkedIn groups, Facebook and Twitter.

4 Additional Membership and Subscription Form (1 Flex Point Each) Page 4 of 5 We encourage Organizational Members to allow their employees to receive full SSPC individual membership benefits and a subscription to the JPCL. Please complete the information below for each additional member and return it with your dues payment. These spots are in addition to your included roster spots. You must use 1 Flex Point for each person listed on this page. If you need additional sheets, please copy this page. Additional Members = 1 Flex Point Each

5 Use Your Flex Points for Books Page 5 of 5 Your SSPC Membership entitles you to a certain number of Flexible Benefits Points based upon the membership level you choose (Patron, Sustaining, etc.). You can use these Flex Points for SSPC publications, extra individual memberships, training discounts and more. To use your points on books, please choose the titles from the SSPC Products Catalog and return your order at any time during your membership. One Book/Publication = 4 Flex Points Note: Flex Points can be used on any publication published by SSPC, however sets like Vol. 1 and 2 count as two (2) selections. Books sold by SSPC but published by outside sources are not available using Flex Points. Flex Points to be use for Publications = Publication titles and catalog numbers: 1. / Catalog Number 2. / Catalog Number 3. / Catalog Number 4. / Catalog Number 5. / Catalog Number 6. / Catalog Number 7. / Catalog Number 8. / Catalog Number 9. / Catalog Number 10. / Catalog Number Send books to: Name for delivery by UPS Please return this form to: Ernie Szoke SSPC Membership Development Specialist SSPC: The Society for Protective Coatings 800 Trumbull Drive Pittsburgh, PA Questions? Tel: Toll Free: Fax: szoke@sspc.org Web: City State Zip SSPC brings together the information, training and technology needed by coatings professionals to assure quality protective coatings projects. R1016

6 Facility Owners Flexible Benefits Worksheet SSPC s Flexible Benefits Points allow you to customize your membership to get the most value for your company. The number of points you get is determined by your level of membership. Flex Points can be used on training courses, books, CD s, individual memberships, QP program fees and more. NOTE: All points MUST be used each year. Points DO NOT carry over when you renew your membership the following year. Choose Your Benefits Please select your benefits based on the tables below. Dollar values are listed for reference purposes only. To use the worksheet, identify whether you are joining SSPC as a Patron or Sustaining Member, then: 1. Choose an option from the Benefit Options column 2. Indicate in the QTY column how many of that option you are requesting 3. Multiply the QTY by the Point Value 4. Enter that total in the last column and then summarize your points in the gray box. Example: You decide to use Flex Points for 3 individual memberships. Find 1 Individual Member in the Options column. You see that it s worth 1 point. Enter the number 3 in the QTY column and then multiply 1 point x 3 QTY = 3 Total Points. Patron CFO Benefit Options (25 points) Sustaining CFO Benefit Options (66 points) Dollar Value Point Value QTY 1 Individual Member $100 1 point 1 Book Avg $125 4 points Fundamentals of Protective Coatings (C1) ecourse $ points Planning/Specifying Coatings (C2) ecourse $ points Marine Coatings (MINE) ecourse $ points Quality Control Supervisor (QCS) ecourse $395 6 points Applicator Training Basics (ATB) ecourse $395 6 points Basics of Steel Surface Preparation ecourse $295 3 points Basics of Concrete Surface Preparation ecourse $245 3 points Basics of Non-Ferrous Metal Surface Preparation ecourse $245 3 points Training Discount Coupon $200 6 points Conference Coupon $550 5 points TOTAL CFO BENEFIT POINTS Point Total for Each Item