APPLICATION FOR MEMBERSHIP SCAFFOLDING, SHORING & FORMING INSTITUTE, INC. We hereby apply for membership in the Scaffolding, Shoring & Forming Institute, Inc. We have read the eligibility information from the bylaws and apply for membership as a Voting Member: Companies that  are actively engaged in the sale of Scope Products,  control the quality of Scope Products by o designing Scope Products; o maintaining written specifications for material and workmanship of such products, and o enforcing such design and specifications through a quality assurance program. In addition, Voting Members must test and rate Scope Products in accordance with applicable SSFI or ANSI standards and must participate in and maintain certification pursuant to any certification program that is adopted by SSFI in the future.

Associate Member: Companies that  are actively engaged in the sale of components used in Scope Products but not the Scope Products themselves,  control the quality of their products by o designing their component products; o maintaining written specifications for material and workmanship of such products, and o enforcing such design and specifications through a quality assurance program. In addition, Associate Members must test and rate their products in accordance with applicable SSFI or ANSI standards, and must participate in and maintain certification pursuant to any certification program that is adopted by SSFI in the future.

Professional Member: Test labs that test Scope Products or components thereof and individuals such as consultants, industry experts, etc., who are not employed by a company eligible for membership.

We apply for membership as follows:

Voting Member in (check all that apply) Forming Section Scaffolding Section Shoring Section Suspended Powered Scaffolding Section Plank/Platform Section

Associate Member

Professional Member

6/10 We submit samples of the following documents to verify our eligibility:

Voting Member: a. Sample drawings for each type* of scope product we produce b. Sample specifications for materials and workmanship for each type* of scope product we produce c. A copy of our quality control manual or equivalent document d. Sample test report forms for each type* of scope product we produce *Scaffold, Shoring, Forming, Suspended Scaffolding, and/or Plank Platform

Associate Member: a. Sample drawings for each type* of component we product for scope products b. Sample specifications for materials and workmanship for each type* of component we produce for scope products c. A copy of our quality control manual or equivalent document d. Sample test report forms for each type* of component we produce for scope products. *one for each type, not one for each component. For example, one caster, or one coupler, etc.

We understand these documents will be held confidential by SSFI staff and will under no circumstances be distributed to other members of the SSFI.

We submit the following documents, as well, for the purpose of demonstrating to the Board of Trustees that we are actively engaged in the sale of scaffolding, and/or shoring, and/or forming, and/or suspended powered scaffolding equipment, and/or planks / platforms, and or components used in scope products.: Catalogs, and/or copies of advertisements, and/or display material, and/or brochures (electronic document or web page is sufficient) We understand this material will be distributed to the other members of the SSFI.

Our company has been in business since . Names of our corporate officers:

President Vice President

If admitted to membership, we would like to appoint as Director: Other trade and/or professional associations of which we are members:

We hereby agree (1) To abide by the bylaws and standards of the Institute as now in force, or hereafter amended; (2) To pay dues and assessments of the Institute as prescribed by the Board of Trustees; (3) That we will not represent that our products meet the recommended criteria of the Institute unless such products have actually been inspected and tested as meeting such criteria. We understand that if our application is not approved by the Board of Trustees, the enclosed $50 application fee shall be retained by the Institute to cover costs incurred. Company Name: By: Address City: State: E-Mail Address: Web Address: Phn: Fax:

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