2008 Membership Application for Proprietary Central Stations

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 __________________________________________

Title ________________________________________________________

Company Name _______________________________________________

Address ______________________________________________________

City/State/Zip _________________________________________________

Telephone _____________________    Fax ____________________

E-mail _____________________________  Web site Address _________________________

Date of Listing of UL Central Station __________       

UL Project Number (For Applicant Members Awaiting UL Listing) ________________________

Is company actively engaged in installing and servicing alarm systems?  ¨ Yes   ¨ No

Is this company owned or controlled by another organization?  ¨ Yes  ¨ No

If yes, please complete the following:

Name of Controlling Organization ________________________________________________

Address ____________________________________________________________________

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

Sponsor Name ______________________________________Telephone No. __________________________

Sponsor's Company Name ___________________________________________________________________

CSAA Membership Dues Structure for Proprietary Central Stations 

Selected category and enclose a check for that amount or complete the credit card information below.
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.

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

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

Name as it appears on the card: __________________________________

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

Authorized Signature ________________________________    Date ______________

Title _______________________________________

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