2025 Occupational Membership Registration Form Company Name * Mailing Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Briefly describe your company/business * Contact Information *Will also serve as the MESA voting members. Contact 1 * First Name Last Name Title * Email * Phone (###) ### #### Contact 2 First Name Last Name Title Email Phone (###) ### #### 2025 Membership Information Select appropriate fee based on the number of employees your organization has: * Please contact the Safety Council at 816-233-3330 if you are unsure if your company is outside the Metro Area. 1-20 Employees: $250 21-50 Employees: $325 51-100 Employees: $375 101-200 Employees: $400 201-500 Employees: $450 501+ Employees: $500 Companies Outside Metro Area $300 Non-Profit, United Way Partner Agencys $250 Are you a returning MESA Member YES, I am a returning MESA Member and will receive a 10% Discount on my membership fees. NO, I am joining as a NEW MESA Member Company Payment Options * Check mailed to: 3131 Frederick Ave, Suite220 St. Joseph, MO 64506 Credit Card (once this form is submitted, you will be routed to an online payment screen) Send invoice to: Email to send invoice to: Please submit any comments or spacial requirements regarding your company's membership. Thank you!
