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Membership Form

CGA is a Washington, D.C., nonprofit organization under §501(c)(3) of the Internal Revenue Code.

*Required fields marked with an asterisk

*Please select the type of CGA membership registration (annual fees are noted):

Corporate/Company ($2,000; 8 individual members)
Association ($3,000; 12 individual members)
Government/Municipality ($1,000; 4 individual members)
Individual ($100)
Sponsorship (choose one):

Bronze ($10,000) Silver ($25,000) Gold ($50,000) Platinum ($100,000)

*Please select stakeholder category/industry that you represent:

Electric
Emergency Services
Engineering/Design
Equipment Manufacturing & Suppliers
Excavation
Gas Distribution
Gas Transmission
Insurance
Locator

Oil
One Call
Other
Public Works
Railroad
Road Builders
State Regulator
Telecommunications

Please provide the following information:

Name of individual member or contact person for corporate membership or sponsorship

*First Name

*Last Name

Position/Job Title

All membership types provide the following

*Company/Employer Name

*Mailing/Street Address 1

Mailing/Street Address 2

*City

*State/Province

*Zip/Postal Code

Country (if not USA)

*Email

*Phone

	Copyright © 2005 Common Ground Alliance All Rights Reserved

	CGA and Dig Safely Campaign are not affiliated with Dig Safe Systems, Inc