AFSA Virginia Chapter 2023 Membership – Please fill out form in its entirety and submit payment below

Company Name *

Mailing Address *

Address Line 1

Address Line 2

City

State

Zip Code

Email Address

Fax #

Company Contact Person
Key individual to receive VA Chapter correspondence

Name / Title *

Secondary contact person in your absence

Name / Title

Membership Category
Please pick one:

Checkboxes *

Contractor Member - Installing, Inspecting, Testing Fire Sprinkler Company ($200.00)
Associate Member - Vendors/Suppliers who support the Fire Sprinkler Industry ($200.00)
Design Firm - Company or person who designs Fire Sprinkler Systems ($125.00)
Auxiliary Member - Any individual, group, association, foundation, firm or industry who agrees to make a
voluntary contribution of a minimum of $50 to help defray the costs to further the objectives and purposes of the Chapter ($50.00)
AHJ's will have no fee for 2023

Credit Card Payments Below:

Message

(Or download our PDF mail in form below)

DOWNLOAD MAIL IN FORM

(Membership does not include meals for meetings)
PLEASE PAY 2023 MEMBERSHIP DUES TODAY!
Thank you for your continued support

Remit Payment and form to: American Fire Sprinkler Association – Virginia Chapter
Attention: Craig Smith
5180 Danes Run
Mechanicsville, VA 23111
Craig.Smith@Ferguson.com