ASSOCIATE MEMBERSHIP APPLICATION

Company Name (as you would like it listed in the Associate Membership Buyers Guide and on the NRECA website)

Product or Service Description (10-15 words):

Primary Contact Name & Title (the person that your company prefers electric cooperatives contact):

NAME

MAILING ADDRESS CITY/STATE/ZIP

TELEPHONE MOBILE FAX

E MAIL WEBSITE

Secondary Contact Name & Title (NRECA will contact this person regarding marketing/advertising/sponsorship opportunities):

NAME TELEPHONE E MAIL

Are you currently working with cooperatives? Yes No

If yes, provide a co-op contact to nominate your company for membership. If no, skip to Level of Membership section.

COOPERATIVE NAME

CITY/STATE TELEPHONE

COOPERATIVE CONTACT NAME & TITLE

Select Your Level of Membership: Platinum ($15,000) Gold ($8,500) Silver ($1,650)

Provide an Invoice Contact (all NRECA invoices will be sent to this person):

CONTACT TITLE

MAILING ADDRESS CITY/STATE/ZIP

TELEPHONE E MAIL

Current tax status: Taxable, Incorporated in the state of Tax-Exempt

Please note: Associate Membership in NRECA does not signify an endorsement of products or services. Associate Members shall not claim or imply that Associate Membership signi es an endorsement by NRECA of products or services.

TERMS OF AGREEMENT

I understand that in order to be eligible for Associate Membership in NRECA, my company’s objectives will contribute to the objectives of the Association. The Chief Executive O cer of NRECA may request that any speci c associate membership be cancelled if (s)he so deems that the speci�c company no longer contributes to the objectives of the Association. If my company becomes ineligible for Associate Membership, any unused Associate Membership bene ts remain the sole property of NRECA.

Authorized Signature Date

SUBMITTING YOUR APPLICATION

STEP 1: Submit Your Application - online at www.nreca.coop/associatemembership or fax to 301.829.6336 or email to DBurton@remagazine.org

STEP 2: Select a Method of Payment

Pay by Check - please mail check and application to: NRECA P.O. Box 758777 Baltimore, MD 21275-8777

Pay by Credit Card: Call 703.907.6875 (be sure to fax/email your application, see Step 1 above.)

Invoice Me (Invoice will be sent directly to Invoice Contact listed above.)

STEP 3: Select up to four (4) business categories on the reverse side of this application

NEED HELP? Contact Danielle Burton via phone, 301.829.6336 or via email at DBurton@remagazine.org.

BILLING/FINANCIAL: Bank/Credit Union Billing Services Collection Agencies E-Commerce Payment Solutions Financial and Administrative Services Financial Audit Services Prepaid Solutions

Tax Analysis and PreparationRating Agency

CONSULTING:

Disaster Planning and Recovery Consulting Engineering Consulting & System Design Environmental Consulting Financial Consulting Human Resources Consulting Information Technology Consulting Management Consulting Property Tax Consulting and Appeals Regulatory Consulting Strategic Planning Systems Integration

EMERGENCY RESTORATION SERVICES: Catering, Shower Facilities, Tents Infrastructure Restoration Standby Power/Interface Equipment

ENERGY EFFICIENCY PRODUCTS &SERVICES:

Consumer Outreach Program Energy Audit Services Energy Management Systems

(In-home displays) Heat Pumps Heat Storage Devices Home Warranties Lighting Water Heaters

HUMAN RESOURCES SERVICES:

A rmative Action Plan Services Background Checks & Drug Testing Certi cation Programs Compensation Analysis Educational Programs Employee Training Employment Web Sites Temporary Sta ng

INFORMATION TECHNOLOGY:

Automatic Vehicle Location (AVL) Computer Equipment Repair Computer Hardware and Software Customer Information Systems (CIS) Mapping, AM/FM/GIS Meter Data Management (MDM) Outage Management Software & Systems SCADA Systems

MARKETING SERVICES: Advertising Agencies and Media Design Firms Corporate Communication, Media and PR Market Research Web Content & Design

METERING: AMI/AMR Meter Reading Services Metering Equipment Power Theft Prevention

POLES: Pole Inspection and Treatment Pole Line Hardware (Insulators/Connectors) Poles and Crossarms

POWER GENERATION: Power Generation Equipment Power Plant Decommissioning/ Dismantling Power Plant Design & Construction Power Plant Maintenance & Operations

SAFETY: Safety Equipment and Inspection Services Safety Training & Education Signs/Labels/Markers/Tags (Work Site) Uniforms and Protective Clothing

SECURITY: Cyber Security Residential Security Equipment/Monitoring Substation Security Products and Services

TRANSMISSION & DISTRIBUTION T&DSYSTEMS:

Rigging Supplies System Protection Equipment T&D Line Construction/Maintenance

Equipment T&D Line Construction/Maintenance Services T&D System Equipment (Switchgear,

Reclosers)

OTHER: Aerial Devices Alternative Energy (non-renewable) Appliances Architectural Design (Buildings) Asset Management Association/Professional Society Audiovisual Products & Services

BatteriesBroadband Infastructure

Buildings & Shelters Cable & Satellite Television Cable Assessment/Testing/Restoration Cable Fault Locators Cables & Wires Call Centers Conferences & Expositions Controls & Instrumentation Cooperative Business Relationship Copper Theft Prevention Demand-Side Management (DSM) Distributed Generation

Distribution Automation Distributors and Manufactures Reps Document Imaging & Work Management Election Services Enclosures/Switchgear/Transformers/Meters Energy Storage Engineering Software Executive Search/Utility Employment Environmental Services Fault Detection Fleet/Fuel Management & Maintenance Government Agencies and/or Programs GPS Products and Services Hazardous Waste Mgmt/Disposal/Containment Insurance Internet Services Inventory Management Legal Services Load Management Mailing & Ful llment Services Medical Services, Prescriptions, Devices Mobile Workforce Management Systems Gases, Oils, Propane Equip/Distribution Nuclear Energy O ce Equipment & Supplies Pest Control Phase Converters Power Factor Correction Power Marketing: Purchase/Sell/Trade

Electricity Power Marketing: Forecasting/Data Analysis Power Quality Printing Promotional Items/Service Awards Publishers/Publications Reel Handling Equipment Regulatory Compliance Products & Services Remanufactured and Recycled Products Renewable Energy (All Types) Right of Way Clearing Risk Management Scrap Metal Shipping & Transportation Services Software Application Providers Staking and Survey Stray Voltage Substation Construction Substation Equipment Substation Maintenance, Repair & Testing Supply Chain Solutions Surge Protection Telecommunications Testing Equipment Tools Trailers Transformer Maintenance/Repair & Testing Transformers, Transformer Pads Underground Cable Equipment & Hardware Utility Locating Services Vegetation Management Equipment Vegetation Management Services Vehicles (Automobiles/Trucks) Voice Response/Phone Noti cation System Wastewater Treatment Weather Forecasting, Lightning Detection Wildlife Protection Equipment Wireless Communication

ASSOCIATE MEMBER PRODUCT & SERVICE CATEGORY SELECTION

Please select up to four (4) categories that best describe the product and services provided by your organization.

www.nreca.coop/associatemembership