Corporate Name (Parent Company) Division (Corporate Name) Street Address City, State, Zip Mailing Address (idierent) Phone ( ) Fax ( ) E-Mail URL www. Year Established and ia Corporation, Place oIncorporation *President/CEO *Vice President Applicant has reviewed the applicable By-Laws and believes it is qualifed. Applicant understands membership in MHIA is a requirement or membership in MHIA Industry Groups, which have Rules on eligibility that may dier rom MHIA (see Page 2 Section B). Iapproved or membership in the Industry Groups, Applicant agree s to abide by the respective By-laws or Rules, as amended rom time to time, i ncluding, but not limited to, responsibility or timely payment odues and assessments. Applicant understands that each Industry Group must approve its application according to their respective By-Laws. Membership in MHIA does not guarantee or imply acceptance or eligibility or acceptance in MHIA Industry Groups APPLICATION FOR MEMBERSHIP IN THE MATERIAL HANDLING INDUSTRY OF AMERICA A. GENERAL INFORMATION *Names will be listed as certifed MHIA representatives and must be executive ofcers or ofcials. Please answer (1), (2), (3), (4) (5) and/or (6) below, whichever applies to your company as defned in the MHIA By-Laws Article I - Defnitions, Section 1.1. (Check appropriate box (es)): (1) For manuacturers, as defned by the MHIA By-Laws Art icle I, Section 1.1(h). (2) For systems acilitators/integrator s, as defned by the MHIA By-Laws Article I, Section 1.1(o). (3) For consultants/simulators, as defned by the MHIA By-Laws Article I, Section 1.1(p) and Section 1.1(q). (4) For publishers, as defned by the MHIA By-Laws Article I, Section 1.1(k). (5) For third party logistics providers, as defned by the MHIA By-Laws Article I, Section 1.1(r). (6) For sotware developers, as defned by the MHIA By-Laws Art icle I, Section 1.1(g). Please list below material handling equipment, systems, publications and/or services oered or sale or distribution in the United States. 5/10 Edition Please complete and return to: MHIA Membership Department 8720 Red Oak Blvd. Suite 201 Charlotte, NC 28217-3992
