Organization Information Company Address City
State/Province
Zip/Postal Code
Country
Phone
FAX
Branches Official Representative Representative’s E-Mail
Title
Company’s Web Address
Organization’s LinkedIn Page Organization Description
Instagram Handle
Facebook Page
Does the Organization employ EGSA technicians? n Yes n No How did you hear about EGSA? n Website n Powerline magazine n Colleague n PowerGen n Social Media n Internet Search n Other_____________ Why are you joining EGSA? n Certification Program n CEU Program n Power Schools n Buying Guide Listing n Networking n Committees n Other__________
Membership Dues (Please fill in the appropriate TOTAL amount from the dues schedule on page one.) Membership Dues $ Membership Plaque (optional)** $ 102.00 On-Site Power Generation: A Comprehensive Guide to On-Site Power (optional)** $ 275.00 Florida Residents: Add 7% Sales Tax to ** items $ ** Shipping and handling is included for Continental US & Canadian Residents. All others should call EGSA Headquarters for $ shipping charges for **items. TOTAL $ Payment Method Payment is prorated based on the membership start date, covering the remainder of the calendar year. Following acceptance of your application, EGSA Staff will reach out directly with detailed instructions for completing your payment. We appreciate your interest and look forward to your membership.
Member Classification Please use the worksheet on page one of this application to determine your membership type .
MANUFACTURER MEMBERSHIP n MF Manufacturer Membership ORGANIZATIONAL MEMBERSHIP n DD Distributor/Dealer Membership n CI Contractor/Integrator Membership
INDIVIDUAL MEMBERSHIP n MIL Military Membership n STU Student Membership n RET Retiree Membership n IND Individual Membership n EI Educational Institution n GM Government n NP Nonprofit n PS Professional Services Firm n CSE Consulting Specifying Engineer
n MR Manufacturer’s Representative Membership n SMTR Service, Maintenance, Monitoring, Testing, and Repair Companies Membership n RC Rental Companies Membership n UIE Utilities, IPPs, and Energy Services Companies Membership n EU End-User
Number of Employees: n 1-20 n 20-100 n 100-500 n 500+ Annual Revenue: n $0-$500k n $500k-1.5M n $1.5M-$2.5M n $2.5M-$5M n $5M-$10M n $10M-$20M n $20M-$50M n $50M-$100M n $100M-$1B Organization Demographics This information is for internal EGSA purposes only. It does not appear in the EGSA Buying Guide or the Member Directory.
EGSA Buying Guide Listing Info
Sells Rents Services
Sells Rents Services
Sells Rents Services
Batteries/Battery Chargers Control/Annunciator Systems Emission Control Equipment Enclosures, Generator Set Engines, Diesel or Gas Education Engine Starters/Starting Aids Filters, Lube Oil, Fuel or Air Engines, Gas Turbine
Generator Laminations
Silencers/Exhaust Systems/Noise Abatement
n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n
n n n n n n n n n n n n n n n n n n n n n n n n n n n n n n
n n n n n n
Generator Sets
Solenoids
Generators/Alternators
Switchgear and Transfer Switches (Automatic or Manual), Bypass Iso-lation Switches, and/or Switchgear Panels
Governors
Heat Recovery Systems
n n n n n n n n n n n n n n n n n n n n n
Instruments and controls, including meters, gauges, relays, contactors, or switches
Trailers, Generator Set
Transformers
Load Banks
Uninterruptible Power Supplies
Motor Generator Sets Radiator/Heat Exchangers
Vibration Isolators Voltage Regulators
Fuel Cells
Fuel Tanks and Fuel Storage Systems
Relays, Protective or Synchronizing
Wiring Devices or Receptacles
For Distributor/Dealers, Manufacturer’s Representatives and Contractor/Intergrators Only— List the manufacturers that your organization represents, deals or integrates:
For Manufacturers Only— List your organization’s Representatives, Distributors and Contractor/Integrators:
Sponsor(s): A”Sponsor” is an EGSA Member who interested you in filling out this application. It is not mandatory that you have a sponsor for the Board to act favorably on this application; however, if a Member recommended that you consider membership, we request that individual’s name and company name for our records. Sponsor Name Company Name
Official Representative’s Authorization Signature
Date
48 | Winter 2025 POWERLINE For any EGSA Membership questions, please contact us at info@egsa.org.
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