Golden State Chimney Sweep Guild
www.cachimneysweepsguild.org
Golden State Chimney Sweep Guild Membership is $150.00 per fiscal year, 11/1/2012 thru 10/31/2013.
All memberships expire 10/31. All members will receive the following:
* GSCSG quarterly publication: ChimNews* * Registration fee reduction to the Convention & Trade Shows
* FREE WORKSHOP (Northern or Southern)* * Membership Certificate (suitable for framing)
* Membership Embroidery patch (new member)* * Official GSCSG T-Shirt (new member)
* GSCSG logo advertising slicks (requested)* * 2 GSCSG vehicle decals (requested)
* ID badge 1-1/2x1-1/2 photo (optional)
New or Renewal (Circle one) PLEASE PRINT CLEARLY Date _________________
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Name Spouse
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Business Name
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Address City, State, Zip
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Business Phone ( ) Fax # ( )
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Home Phone ( ) Email:
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Website: :
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Additional Members $100.00 each T-Shirt size (new member only)
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Spouse
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Employee Employee
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Additional Information can be written on the back: Send employee packet to:__________________________
GSCSG Certified: Yes No Certification # ________________ Expires ____________
C.S.I.A. Certified: Yes No Certification # ________________ Expires ____________
F.I.R.E. Certified: Yes No Certification # ________________ Expires ____________
N.F.I. Certified: Yes No Certification # ________________ Expires ____________
State Licensed Contractor? Yes No License Classification(s) ___________________________
Interested in being a mentor? Yes No Are you interested in being mentored: Yes No
Please send completed application, your check, and/or credit card information along with 2 business cards to:
G.S.C.S.G. Treasurer, Charlie Baltimore
7957 Cypress Ave., Rosamond, Ca. 93560
Ph. # 661-256-1344
Visa or Master Card: # __________________________________________________ Expires _____________
Signature _________________________________________________________________________________
For more information, call or email:
Membership Director: Joseph Maholick
562-945-4646 smokeyjoeschimneysweep@yahoo.com
Rev.7/17/12
