Washington State Recycling Association
Membership Form
Contact Name
*
First Name
Last Name
Company Name
*
Company Webpage
Email
*
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
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Company Logo (skip if individual membership)
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Large Organization Membership
Enter description
$
700.00
Quantity
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10
Mid Size Organization Membership
$
500.00
Quantity
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2
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Small Organization Membership
$
300.00
Quantity
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Nonprofit Membership
$
175.00
Quantity
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Individual Membership
$
125.00
Quantity
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2
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Senior & Student Membership (non voting)
$
50.00
Quantity
1
2
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10
Gold Precious Metal Partnership
$
5,000.00
Quantity
1
2
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10
Silver Precious Metal Partnership
$
3,000.00
Quantity
1
2
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10
Bronze Precious Metal Partnership
$
1,500.00
Quantity
1
2
3
4
5
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10
Credit Card Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
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