COMPANY: ___________________________________________________________________________

ADDRESS:____________________________________________________________________________

CITY: ___________________________________________ STATE:_______ ZIP__________________

TELEPHONE:_______________ FAX: ___________________EMAIL: _________________________

TYPE OF BUSINESS:____________________________________________________________________________

Standard Industrial Classification:_______ NUMBER OF EMPLOYEES:_______________

____________________________________________________
Authorized By

____________________________________
Title

____________________________________
Date

A membership investment is based on the average number of active employees of all classifications engaged in work within the area and on the company’s payroll for the preceding twelve month period. The investment will cover the period of one year from the date of membership, and, thereafter, will be payable on the anniversary date of membership. The GEA is a non-profit organization within Internal Revenue Service guidelines, and the investment is deductible as a routine business expense.

MINIMUM MEMBERSHIP (112 or LESS EMPLOYEES) $450.00

MEMBERSHIP PER EMPLOYEE (113-624 EMPLOYEES) $4.00

MAXIMUM MEMBERSHIP (625+ EMPLOYEES) $2500.00

IN CONSIDERATION OF SERVICES PROVIDED AND THE WORK BEING DONE BY THE GEORGIA EMPLOYERS’ ASSOCIATION FOR THE BENEFIT OF EMPLOYERS THROUGHOUT THE STATE OF GEORGIA, WE AGREE TO SUPPORT THE ASSOCIATION AND PAY THE FOLLOWING INVESTMENT:

$___________ FOR _______ EMPLOYEES. CHECK ENCLOSED:_____ BILL COMPANY:_____

MEMBERSHIP SHALL AUTOMATICALLY BE RENEWED EACH YEAR UNLESS WRITTEN NOTIFICATION TO THE
CONTRARY IS RECEIVED BY THE GEA.

MEMBER COMPANY PROFILE

(PLEASE PRINT OR TYPE ALL INFORMATION)

DATE:_______________________________ MEMBERSHIP: _____RENEWAL _____NEW

COMPANY:_________________________________________________________________________________________________

ADDRESS:__________________________________________________________________________________________________

CITY: ________________________________________________ STATE:_____________________ZIP:______________________

TELEPHONE:__________________________ FAX: ___________________________EMAIL:___________________________

TYPE OF BUSINESS:_________________________________________________________________________________________________

Standard Industrial Classification:_________________________ NUMBER OF EMPLOYEES:_________________________

UNION: NO _____ YES_____ IF YES, NATIONAL UNION:______________ LOCAL:____________________________

COMPANY POINTS OF CONTACT:

* SENIOR MANAGEMENT OFFICIAL

NAME:_____________________________________________________________________________________________________

TITLE:____________________________________________________________________ PHONE EXT:__________

SEND: Management Report only Y____N____ or All Materials Y____N____

* HUMAN RESOURCE OFFICIAL NAME: ___________________________________________________________________________________

TITLE:____________________________________________________________________ PHONE EXT:__________

SEND: Management Report only Y____N____ or All Materials Y____N____

* GEA POINT OF CONTACT NAME:________________________________________________________________________________________

TITLE:____________________________________________________________________ PHONE EXT:__________

SEND: Management Report only Y____N____ or All Materials Y____N____

Email address: ________________________________________________________

Unless initialed here, we agree to receive faxes, email and other correspondence from the Georgia Employers Association.

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