Company Name:__________________________________________________

Street Address:___________________________________________________

City:_______________________________ State:_________ Zip:__________

Telephone:________________________ Fax:__________________________

Name of Principal Contact:__________________________________________

Email address: _____________________ Website: __________________

Any information you may wish to provide on your company:

_______________________________________________________________
_______________________________________________________________
_______________________________________________________________
_______________________________________________________________

Submission of this application gives SPIDA permission to contact you by mail,
telephone, email or fax.

ANNUAL DUES ARE $500 in US dollars. Please include a check, made payable to
SPIDA, with your application and return to:
SPIDA
P. O. Box 1665
Irmo, SC 29063

Or provide the following credit card information (the credit card charges will be
processed by the management company, Sylvester Management Corp.)

Card Type: _____ Amex _____ MasterCard _____ Visa
Card Number ______________________________ Exp. ___/___
Name on Card__________________________________________
Signature authorizing charge ______________________________