NEW MEMBERSHIP

Please review all membership and billing policies before completing all information in this application.

Terms & Policies

NEW MEMBERS & RENEWAL: $400.00 per calendar year

Make your check payable to:

Rio Plex Safety Council, Inc.
110 S. Col Rowe Blvd/2nd St.

McAllen, TX 78501

For questions or to arrange payment call (956) 928-1967

Fill up the Credit Card Authorization Form and Medical Form along with your Membership Sign Up Form below.

CREDIT CARD AUTHORIZATION FORM

MEDICAL CLIENT INFORMATION FORM

New Membership Form

COMPANY NAME

Mailing Address

MAILING ADDRESS

STREET

CITY

STATE

ZIP

Billing Address

BILLING ADDRESS

BILLING ADDRESS

Same As Mailing Address

Different Address

STREET

CITY

STATE

ZIP

Physical Address

PHYSICAL ADDRESS

Physical Address

Same As Mailing Address

Different Address

STREET

CITY

STATE

ZIP

Contacts

CONTACTS

Primary

PRIMARY

FIRST NAME (Primary)

LAST NAME (Primary)

TITLE (Primary)

PHONE (Primary)

EMAIL (Primary)

CEO

FIRST NAME (CEO)

LAST NAME (CEO)

TITLE (CEO)

PHONE (CEO)

EMAIL (CEO)

Billing

BILLING

FIRST NAME (Billing)

LAST NAME (Billing)

TITLE (Billing)

PHONE (Billing)

EMAIL (Billing)

Training/HSE

SAFETY

FIRST NAME (Safety)

LAST NAME (Safety)

TITLE (Safety)

PHONE (Safety)

EMAIL (Safety)

Link Administrator

LINK ADMINISTRATOR

Please designate an administrator for your account.

The administrator will be able to set up additional online registration users which will be authorized to make changes to your company account.

FIRST NAME (Primary)

LAST NAME

TITLE

PHONE

FIRST NAME (Secondary)

LAST NAME

TITLE

PHONE

NEW MEMBERSHIP

New Membership Form

CONTACT US