JPCL Trial Subscription Form

* Required Fields

• *Gender

  Male   Female
• *First Name
  Middle Initial
  *Last Name
  *Job Title
• Age
  *Company Name
• *Company Address
  *City
• *State or Province
  *Country
• *Zip
  # Employees
• *Telephone
  Fax
• *Email

• Web Address
• Other Association Membership
  Education Level or Other Certifications Held

• *1. What kind of company do you work for?
• A. Facility Owner (end user of coatings)
• B. Coating and Lining Contractor
• C. General Contractor
• D. Specialty Contractor
• E. Concrete/Flooring Contractor
• F. Shop Fabricator
• G. Plant Fabricator (OEM)
• H. Architect, Engineering, Consulting
• I. Ship Owner
• J. Coatings Manufacturer
• K. Raw Materials Manufacturer
• L. Equipment Manufacturer
• M. Abrasives Manufacturer
• N. Coatings Distributor, Dealer or Store
• O. Equipment Distributor, Dealer or Store
• P. Research or Regulatory Agency
• Y. Other (specify)

• * 2.In terms of coating work, what do you do? Check as many as apply
• A. Purchase or specify coatings
• B. Manage programs or projects
• C. Purchase or specify equipment
• D. Industrial hygiene or safety
• E. Environmental compliance
• F. Testing, research, formulating
• G. Sales and marketing
• H. Technical Service
• I. Executive management
• J. Applicator
• K. Blaster
• L. Regulator
• Y. Other (specify)

• 1. How do you prefer that SSPC contacts you?
• A. Email Communications from SSPC
• B. Hard Copy Mail
• C. Other (specify)

• 2. In the box provided below, please type a short description of what service your company performs.

• *3. How did you become involved in the Coatings Industry? (apprenticeship program, trade school, family owned business, etc.) Type a short summary in the box below.