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TRI-STATE SAFETY ASSOCIATION

Providing professional networking and training in safety, health and environmental practices

Tri-State Safety Association

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Annual Membership / Sponsorship Form

TSSA Status

New Member/Sponsor

Returning Member/Sponsor

Company name*

Address

Phone

Membership Only

Primary Membership$165

Associate Membership (with paid Primary Membership)$100

Membership includes attendance at all monthly luncheons during the calendar year plus a free guest attendee at one luncheon.

Memberships are assigned to the company, not the individual, unless requested. Alternate company representatives may attend in place of listed Primary or Associate members. Additional attendees are subject to the guest attendee fee of $25 each.

Annual Sponsorships

Elite Partner (includes Primary & Associate membership)$800

Premier Partner (includes Primary membership)$650

Principal Partner$500

Lunch Sponsorship

Individual Sponsorships

Lunch Sponsor for 1 monthly luncheon$100

Conference Sponsorships

May also be paid through conference registration page (when available)

Conference Sponsorships

Platinum Sponsor$250

Gold Sponsor$200

Silver Sponsor$150

Bronze Sponsor$100

Payment Preference

Check (Payable to TSSA, PO Box 42, Wahpeton, ND 58074)

Credit Card

Questions?

Tri-State Safety Association

PO Box 42

Wahpeton, ND 58074

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Tri-State Safety Association is a 501(c)(3) non-profit organization.

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