Apply Now

(562) 296-8854

Membership Application

The Association’s membership term begins on July 1st each year. The membership dues are $50.00 per year. Please submit your dues payment with this application to the association office. In the years following, you will be billed annually for dues, which are due on or by July 1st.

We hereby apply to the California Merchants Safety Association for membership. We agree to abide by the Constitution and Bylaws of the California Merchants Safety Association.

* Indicates required field

Company Name *

Date *

Address *

State *

City *

Zip *

Fax Number *

Email *

Name of Officer 1 *

Name of Officer 2 *

Name of Officers 3 *

Contractor’s License # *

Classification *

Choose One *

Individual Partnership Corporation

Years in Business *

Workers Compensation Company *

Workers Comp. Expiration *

Your Name *

Title *

Date *

Comment *

Submit

Membership Application​

Become a member today!

Membership Application