CONNECTICUT GEOTHERMAL ASSOCIATION
MEMBERSHIP APPLICATION
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Name: Phone: |
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Street Address: Fax #: |
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P.O Box : Website: |
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City & State : Zip Code: |
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Title: Email: |
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Signature: Cell #: |
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Primary Member Type from list below: ___________________ Amount enclosed: $__________ Active involvement in ground source industry in CT: __________________________________________________________________________________________
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Voting Memberships
o A. Corporate- $250/company includes up to two individuals. Additional individuals within corporate membership -$50/person. One vote per corporate membership
o A. Individual- $85/Individual. One vote per individual
o B. Manufacturer/Distributor/Supplier/Service provider - $350/company includes one individual. Additional individuals within corporate membership-$50/person. One vote per company membership
Non-Voting Associate Memberships
o C. Accredited Professional (AIA, PE, MEP, LEED, etc.) / Associate - $30/person
o D. Utility/Energy Agency
Public regulated utility-Complimentary
Private Utility-$250/company
o E. Government/Public Educational – Complimentary
o F. Student (Must be F.T. @ accredited university / friend of CT Geothermal - $15
Memberships are valid for the calendar year July 1st through June 30th annually. Please make checks payable to
CONNECTICUT GEOTHERMAL ASSOCIATION
Memberships applications can be submitted at monthly meetings or mailed to CONNECTICUT GEOTHERMAL ASSOCIATION C/O Guy Wanegar –President, PO BOX 1356, SOUTH WINDSOR , CT. 06074
Please print out this form for submittal. Thank you