Associate Membership Application Form Companies classified in Workplace Health Safety and Compensation Commission (WorkplaceNL) Newfoundland Industrial Classification (NIC) codes other than construction, are eligible to join the NLCSA as Associate Members. ASSOCIATE MEMBERSHIP APPLICATION INFORMATION Date:_____________________ Company Name: Contact Name: Ms. Mr. WorkplaceNL NIC Code: No. of Employees: (approximately) (Please attach proof of WorkplaceNL Firm # and NIC Code) Address: City: Province: Postal Code: Phone Number: Fax Number: Email: Web Page: Please list any or affiliated companies: Associate membership fees are payable annually and are based on company size # Employees 1 - 2 3 - 10 11 - 30 31 - 50 51 + Annual Fee $125.00 $325.00 $625.00 $900.00 $1125.00 HST $16.25 $42.25 $81.25 $117.00 $146.25 Total Annual $141.25 $367.25 $706.25 $1,017.00 $1,271.25 Fee Please send completed application and payment to the NLCSA at the address below.
Associate Membership Application Form Companies classified in Workplace Health Safety and Compensation Commission (WorkplaceNL) Newfoundland Industrial Classification (NIC) codes other than construction, are eligible to join the NLCSA as Associate Members. ASSOCIATE MEMBERSHIP APPLICATION INFORMATION Date:_____________________ Company Name: Contact Name: Ms. Mr. WorkplaceNL NIC Code: (Please attach proof of WorkplaceNL Firm # and NIC Code) No. of Employees: (approximately) Address: City: Province: Postal Code: Phone Number: Fax Number: Email: Web Page: Please list any or affiliated companies: Associate membership fees are payable annually and are based on company size # Employees Annual Fee HST 1 - 2 $125.00 $16.25 3 - 10 $325.00 $42.25 11 - 30 $625.00 $81.25 31 - 50 $900.00 $117.00 51 + $1125.00 $146.25 Total Annual Fee $141.25 $367.25 $706.25 $1,017.00 $1,271.25 Please send completed application and payment to the NLCSA at the address below.
Associate%20Membership.docx