SCIC Membership Application

To join the SCIC, please provide us with the following information. An SCIC representative will contact you to discuss your membership.

Company Information
Company Name*
Company Type(s)*
- Automotive
- Consumer Goods
- Home
License*
Accepted file types: pdf, jpg, Max. file size: 2 MB.
Please upload a copy of your license (PDF or JPG format only).
Company Address*
Street Address Address Line 2 City State ZIP Code
Phone*
Fax
Website*
Would you like to be included on the public SCIC member list?*
- Yes
- No
Company Logo (optional)
Accepted file types: png, gif, jpg, Max. file size: 1 MB.
For possible display on the website if approved by SCIC administration (PNG, JPG or GIF only).
Primary Contact
This information will also be used in creating the primary credentials for your website member account.
Name*
First Last
Title/Position*
Email Address*
Enter Email Confirm Email
- I would like to enter a Secondary Contact
Secondary Contact
(optional) This information will also be used in creating secondary credentials for your website member account.
Name
First Last
Title/Position
Email Address
Enter Email Confirm Email
Billing Information
Frequency*
- Annually
- Quarterly
Billing Contact*
- Billing address the same as firm address?
Billing Address
Street Address Address Line 2 City State ZIP Code
Submit Application
Comments or Questions
Name
This field is for validation purposes and should be left unchanged.

Company Information