NEW MEMBER APPLICATION

for the

NATIONAL INDUSTRIAL SCALE ASSOCIATION

1932 Industrial Drive
Libertyville, IL  60048
(847) 367-6650  x 155

Please print this page, complete the information below and enclose a check or money order made payable to NISA for $65.00 USD, Foreign $85.00 USD, and mail to the above address.

Name: _________________________ Date: ______________________
Company: _________________________ Telephone: ______________________
Address: _________________________ Fax: ______________________
_________________________ E-Mail ______________________
_________________________
BUSINESS CATEGORY TYPE OF INTEREST
________ Scale User ________ Belt Scales
________ Scale Manufacturer ________ Rail Scales
________ Railroad ________ Truck Scales
________ Regulatory ________ Hopper Scales
________ Dealer/Representative ________ Automatic Equipment Identification
________ Other ________ Electronic Data Interchange
_________________________ ________ Other
_________________________ ________________________
_________________________ ________________________

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