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- About Us
- History & Core Values
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- Consulting Request Form
Training
Resources
My Account
Contact
Online Store

Membership Application

Home / Membership Application

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Dues – Step 1 of 3

Is this a new membership or a renewal? *

New Membership
Membership Renewal

Membership #

Please enter your current membership # if available

# of Employees *

Approximately how many employees? *

Number of Years *

1 Year for 1-10 Employees

Total: $399.00

2 Years for 1-10 Employees

Total: $718.00

3 Years for 1-10 Employees

Total: $1,017.00

1 Year for 11-49 Employees

Total: $549.00

2 Years for 11-49 Employees

Total: $988.00

3 Years for 11-49 Employees

Total: $1,400.00

1 Year for 50-100 Employees

Total: $749.00

2 Year for 50-100 Employees

Total: $1,348.00

3 Year for 50-100 Employees

Total: $1,910.00

1 Year for 101-500 Employees

Total: $1,099.00

2 Year for 101-500 Employees

Total: $1,978.00

3 Year for 101-500 Employees

Total: $2,802.00

1 Year for 501-1,000 Employees

Total: $1,799.00

2 Year for 501-1,000 Employees

Total: $3,238.00

3 Year for 501-1,000 Employees

Total: $4,587.00

1,001+ Employees
Pricing to be determined

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Company *

Company Billing Address

Address Line 1

Address Line 2

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State

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Primary Safety & Health Contact

Primary Safety & Health Name *

First

Last

Primary Safety & Health Phone

Primary Safety & Health Email *

Will the payment be made by someone else?

Billing Contact

Billing Contact Name *

First

Last

Phone *

Email *

Additional Contacts

Would you like to add any additional contacts?

3 2 a

How many additional contacts would you like to add?

Selected Value: 1

Additional Contact 1

First

Last

Additional Contact 1 – Phone

Additional Contact 1 – Email

Additional Contact 2

First

Last

Additional Contact 2 – Phone

Additional Contact 2 – Email

Additional Contact 3

First

Last

Additional Contact 3 – Phone

Additional Contact 3 – Email

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Have questions about membership?

Give us a call at 800-875-4700 or send an email to safety@chesapeakesc.org.

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2555 Lord Baltimore Dr
Suites M-R
Baltimore, MD 21244
800-875-4770
safety@chesapeakesc.org

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