Please print the application and mail to the address shown

MUNICIPAL ELECTRICAL INSPECTORS ASSOCIATION OF NEW JERSEY. INC.

Dedicated to Serving the Electrical Industry

MEIA of NJ Inc.

MEMBERSHIP  APPLICATION

Renewal__    New __ ( check one ]          Date ______________ 20____

Last Name ___________________________ M.I _____First Name___________________

Business Phone # _____ _________________ Job Title __________________________

Business Address __________________________________________________________

Business City __________________________________State _________ Zip __________

Home Address ____________________________________________________________

Home City ___________________________________ State _________ Zip ___________

Home Phone # ______________________

Electrical Inspectors License    YES ____   NO ____   License # ___________

Electrical Contractors License  YES ____  NO ____    License # ___________

Inspector Applicant must accompany application with written verification of employment in a municipality in order for the application to be processed for regular membership. Confirmation not required for associate membership. [ PLEASE PRINT ALL INFORMATION ]

 MAKE CHECKS PAYABLE  TO:

 M.E.I.A. OF N.J., INC.

ANNUAL DUES : $60.00 for 2007