Membership Application

Please mail your check to:
NUCA of Indiana
7439 Woodland Drive
Indianapolis, IN 46278
317.328.2153 Voice
317.328.2545 Fax

Name
Title
Company
Address
City
State
Zip
Telephone	xxx-xxx-xxxx
Fax	xxx-xxx-xxxx
E-mail
How did you hear about NUCA of Indiana?
Membership Type
Contractor	Annual Volume Below $2 million $1000 ($500 State / $500 National) Annual Volume Between $2 and $5 million $2225 ($1000 State / $1225 National) $5 million to $10 million $2975 ($1500 State/$1475 National) Over $10 million $3725 ($2000 State / $1725 National)
Associate	Annual Volume Below $2 million $1175 ($600 State / $575 National) Annual Volume between $2 and $10 million $1375 ($600 State / $775 National) Over $10 million $1575 ($600 State / $975 National)
Institutional	$800 ($400 State / $400 National)
MultiLocation	$875 ($600 State / $275 National)