Name _______________________________________________
Company/Organization ______________________________________
Address __________________________________________________
Address __________________________________________________
City ________________________ State ________________________
Zip Code ________________________
Phone _______________________ Fax ________________________
e-mail ____________________________________________________
IF PAYING BY CREDIT CARD, PLEASE COMPLETE THE SECTION BELOW:
Credit Card Number
________________________________________________________________
Name as it appears on Credit Card ________________________________________
Expiration Date: _______________________________________________
Type: (VISA Master Card)
Three digit code on reverse of card ____________________
Address (if different from above__________________________________________
Address ____________________________________________________________
Signature __________________________________________________________
Note that dues are per person (not per company) and are in effect for the calendar year.
We accept Master Card and Visa only.
Please print the above membership application, and fill it in. If you are paying by check,
make checks payable to: “NYSASWM” (dues are $ 75.00 per person per calendar year) and
mail to:
New York State Association for Solid Waste Management
Membership Department
P.O. Box 13461
Albany, New York 12212
Please note that while NYSASWM is a not-for-profit organization, membership dues are not
tax deductible as a charitable contribution. To the extent permitted under the Internal
Revenue Code, dues may be deducted as a business expense.
New York State Association
for Solid Waste Management
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