GEORGIA STATE INSPECTOR’S ASSOCIATION INC.
     2573 Bonds Lake Road, Conyers, GA, 30012
                             (770) 595-9887

  2021 Membership Application Form 
	Active Membership (Full Time Inspectors and Government Employee)       - $35.00   (  )      

Associate Membership 
Lifetime Member (Awarded by Membership) 
NAME: ____________________________ 

 - $50.00   (  )       
 - N/C     (  ) 

	EMPLOYER/COMPANY AFFILIATION:  _____________________________ 

	POSITION/TITLE: ___________________________ 
ADDRESS: __________________________________

CITY:_______________________

STATE:_________    ZIP: __________

	PHONE #   WORK: ___________________   CELL: ____________________
EMAIL ADDRESS: ____________________________________________  
Make check to: Georgia State Inspectors' Association, Inc. 
Mail to: GSIA, 2573 Bonds Lake Road, Conyers, GA, 30012
 
To pay by Credit card go to:  http://www.gsiaonline.com/join-gsia

For additional Information contact Ron Anderson (770) 595-9887

Email: randerson@gpta.net