Full Membership Application Form Company Name * Company Address * Address 1 Address 2 City State/Province Zip/Postal Code Country Main Contact Name * Main Contact Telephone * Main Contact Email * Company Type * Limited Company Sole Trader Partnership Do you operate as: Main Contractor Sub Contractor Company Turnver / Annual Membership Dues * Your membership dues are calculated by your annual turnover Annual Company Turnover: £0 - £1,000,000 - Membership Dues £1,619 Annual Company Turnover: £1,000,000 - £1,250,000 - Membership Dues: £1,826 Annual Company Turnover: £1,250,000 - £1,500,000 - Membership Dues: £2,088 Annual Company Turnover: £1,500,000 - £1,750,000 - Membership Dues: £2,611 Annual Company Turnover: £1,750,000 - £2,000,000 - Membership Dues: £3,132 Annual Company Turnover: £2,000,000 - £2,500,000 - Membership Dues: £3,653 Annual Company Turnover: £2,500,000 - £3,000,000 - Membership Dues: £4,594 Annual Company Turnover: £3,000,000 - £3,500,000 - Membership Dues: £5,115 Annual Company Turnover: £3,500,000 - £4,000,000 - Membership Dues: £5,533 Annual Company Turnover: £4,000,000 - £4,500,000 - Membership Dues: £5,949 Annual Company Turnover: £4,500,000 - £5,000,000 - Membership Dues: £6,472 Annual Company Turnover: £5,000,000 - £5,500,000 - Membership Dues: £6,889 Annual Company Turnover: £5,500,000 - £6,000,000 - Membership Dues: £7,411 Annual Company Turnover: £6,000,000 - £6,500,000 - Membership Dues: £7,932 Annual Company Turnover: £6,500,000 - £7,500,000 - Membership Dues: £8,454 Annual Company Turnover: £7,500,000 - £8,500,000 - Membership Dues: £8,977 Annual Company Turnover: £8,500,000 - £10,000,000 - Membership Dues: £9,759 Annual Company Turnover: £10,000,000 + Please get in touch with us for bespoke pricing Number of Employees Health and Safety Rep Name: Details of the Director responsible for safety matters in your company Position Do you have a health and safety policy? Yes No Please provide details of any safety training provided to your employees and supervisors in the past 12 months: Has any HSE enforcing action been taken against your company (Improvement or Prohibition Notices or prosecutions) over the past three years? * Yes No If yes, please provide details of further details: How many active projects are ongoing? * Declarations: I / We Hereby Apply For Membership Of The Eastern Builders Safety Group Limited (The Group) And By Signing this Declaration Confirm That: I / We have read and agree to be bound by the memorandum and articles of association and by-laws of the group for the time being. I / We agree to pay my / our subscription in accordance with the memorandum and articles of association and understand that the current rate of subscription for Full Membership is calculated by reference to turnover. I / We have read and agree to the terms and conditions of membership. The information provided in this form is true and correct to the best of my / our knowledge. I / We agree to return the following documentation with this application, if applicable: ✓ Details of our notifiable accident record for the last 3 years ✓ Copy of our current health & safety policy Declaration Agreement * I / We agree Thank you!We will be in touch….
