WHMA

Regular Membership Application

PLEASE BE SURE TO COMPLETE ALL APPLICATION INFORMATION. APPLICATIONS WILL NOT BE PROCESSED UNLESS THEY ARE COMPLETE.

Company

Address

City

State

Country

Zip

Mailing Address
(if different than above)

City

State

Country

Zip

Company Website

Company Email

Who Referred you
to WHMA?

Main Contact

Name

Title

Phone

Fax

Email

This individual will be volunteering in WHMA Comittees



Secondary Contact

Name

Title

Phone

Fax

Email

This individual will be volunteering in WHMA Comittees



Harness Manufacturers Association as follows:

Regular Member (Full Voting Member) - We are a proprietorship, firm, or corporation in the Western Hemisphere engaged in the manufacture of wiring harnesses, electronic cable assemblies, or cordsets in operation since the year and derive substantial sales, in the amount of $ (US Dollars), from the manufacturers of finished products made from the combination of wire, cable, connectors, and terminals.

WHMA Regular Membership Annual Dues

When you submit this application, you will be taken to a secure web page to collect your payment information.