CSAA's Membership Application for Associate Members

We hereby apply for membership in the Central Station Alarm Association. If our application is approved, we agree to observe the Bylaws of the Association and give due consideration to all lawful activities that will contribute to its advancement and growth.

Contact Person / Official Representative __________________________________________

Company Name ____________________________________________________________________________

Address __________________________________________________________________________________

_________________________________________________________________________________________

E-mail _____________________________ Web site Address ___________________________________

All applicants must be sponsored by one CSAA Member in good standing with the Association.

Sponsor's Company Name ___________________________________________________________

Amount of check enclosed (check appropriate category on the following table).
NOTE: Companies outside the U. S. must pay by bank wire transfer or credit card. For banking information, please contact Madeline McMahon, CSAA Vice President of Finance, at finance@csaaul.org or 703-242-4670, Ext. 14.

	Company Gross Revenues	Annual Dues
____	Less than $3 million	$1,925
____	At least $3 million, but less than $4 million	$2,200
____	At least $4 million, but less than $6 million	$2,300
____	At least $6 million, but less than $15 million	$2,500
____	At least $15 million, but less than $30 million	$3,500
____	At least $30 million, but less than $55 million	$5,000
____	At least $55 million, but less than $120 million	$7,000
____	At least $120 million, but less than $200 million	$10,000
____	At least $200 million, but less than $300 million	$14,000
____	At least $300 million, but less than $400 million	$18,000
____	At least $400 million, but less than $500 million	$22,000
____	At least $500 million, but less than $600 million	$26,000
____	At least $600 million, but less than $700 million	$30,000
____	At least $700 million, but less than $800 million	$34,000
____	$800 million or greater	$38,000

Please return this form with your one year's dues to: CSAA, 440 Maple Avenue East (#201), Vienna, VA 22180. Dues apply to the calendar year (January-December).

____Payment enclosed made payable to CSAA _______ Please charge my credit card (Visa, MasterCard, American Express)

Card Number: _________________________________Security Code (Mandatory):________Exp.Date (Mandatory):________

For more information, contact Becky Lane, CSAA's Director of Membership at 703/242-4670, Ext. 18 or memberservices@csaaul.org.

Privacy Statement: Any financial information requested on this form will be disclosed only to CSAA staff for the sole purpose of setting the appropriate dues. This information will not be made available to members of the association or any other parties.

The above information is submitted for the purpose of obtaining membership in the Central Station Alarm Association, and is warranted to be true and correct. Permission is hereby granted to CSAA to request information from the above-named sponsor or any other source. We understand that one year's fees are due and payable in advance in accordance with the terms that shall then be in effect, or otherwise directed by the Board.