Dues Notice

JEFFERSON COUNTY AREA SAFETY NETWORK – www.jeffersonsafetynetwork.org

2017 – 2018 Dues Notice & Contact Update

Note:  Due date for membership is September 7, 2017

BUSINESS/COMPANY:      ______________________________________________________

PRIMARY CONTACT:        ______________________________________________________

TITLE/POSITION:                ______________________________________________________

MAILING ADDRESS:         ______________________________________________________

BUSINESS PHONE:             (________)________________FAX: (________)______________

E-MAIL:                                 ______________________________________________________

E-MAIL ADDRESSES: (Additional company contacts)
Note:  Please provide as many e-mail addresses as appropriate for your organization.


Not a member but would like meeting notices and safety/health updates—include your e-mail address.

2017– 2018 annual dues are $75.00 per company.  This allows each company/member to send as many employees to meetings as desired at the $20.00 rate per person attending.

Special Prize Drawing:

For every member attendee that pre-registers and attends a meeting, the company will be entered into a drawing. Drawing: March 8, 2018. Prizes: Two 2-day registrations for companies to attend the Wisconsin Safety and Health Conference held April 17th & 18th, 2018 at the Kalahari, Wisconsin Dells.


Checks should be made out to and returned with this membership form to:

Jefferson County Area Safety Network
C/o Mary Hughes
P.O. Box 297
Fort Atkinson, WI 53538

(920) 568-6543