USA North Membership

USA NORTH MEMBERSHIP APPLICATION FORM

Organization:

Contact:

Phone: Fax:

Email:

Mailing Address:

City: State: Zip:

Delivery Address:

City: State: Zip:

Billing Information:

Contact: Phone:

Email:

Mailing Address:

City: State: Zip:

Annual Billing Selection: Jan-Dec: Jul-Jun:

Invoicing Method Selection: Electronic: US Mail

To help you fill out the correct Rate information below, click “USA NORTH RATE STRUCTURE GUIDE”

Rate I - Mileage (not trench mile):

Cable TV: Electric: Gas: Pipeline: Telecom:

Rate II - Population Selection:

City (Incorporated): County (Unincorporated): Other:

Rate III - Mileage:

Irrigation: Sanitation: Water:

Or
Rate III Option for Sanitation and Water Companies - Total Commercial and Residential hookup:

Sanitation: Water: (hookups X Rate II)

Rate II and III Reminder - If your organization also provides other entities with Cable TV, Electric, Gas, Pipeline, and/or Telecom services, you are required to submit that mileage in Rate I above.

If you have any questions please contact Linda Whitley at lwhitley@usan.org,
Phone (800) 640-5137 ext 2202 Click SEND to submit form directly to lwhitley@usan.org

USA North Rate Structure Guide:

Rate structures I, II and III below, are used to determine the USA North member’s annual membership cost. Please review each rate category in order to determine the correct rate structure for your organization:

RATE I - Cable TV, Electric, Gas, Pipeline, & Telecom Facilities

$.894 per mile of underground sheath, circuit, or pipeline facilities (Main line facilities and product lines) x 12 months – (minimum annual membership cost is $150.00)
Rural telephone or electric companies with less than 300 access lines will pay $150.00 annually

RATE II - Cities, Counties, School Districts, and Parks (Fire Alarm, Internal Telecom, Sewer, Street Lights, Traffic Signals, & Water Facilities Only)**

$1.273 per 1,000 population served, (cities incorporated, counties unincorporated, using the official CA State and NV State Estimates Reports) x 12 months – (minimum annual membership cost is $150.00)

RATE III - Irrigation, Sanitation, or Water Facilities**

$.378 per mile of underground pipeline facilities x 12 months – (minimum annual membership cost is $150.00)

Sanitation and Water companies may select Rate II or Rate III. If Rate II is selected, the total number of commercial and residential hookups for all facilities will be multiplied by 2.64 to determine their population figure

**If your organization also provides other entities with Cable TV, Electric, Gas, Pipeline, and/or Telecom services, you are required to submit that mileage in RATE I

Annual Membership Cost Examples:

RATE I – An Electric/Telecom Member has 100 circuit miles of underground electric and 50 sheath miles of underground telecom:

100 x $.894 = $89.40 x 12 months =	$1,072.80
50 x $.894 = $44.70 x 12 months =	$536.40
	$1,609.20	annually

RATE II – A City Member has 50,000 population and 20 sheath miles of underground telecom:

50 x $1.273 = $63.65 x 12 months =	$763.80
20 x $.894 = $17.88 x 12 months =	$214.56
	$ 978.36	annually

RATE III – A Water/Electric Member has 100 miles of underground water and 20 circuit miles of underground electric:

100 x $.378 = $37.80 x 12 months =	$453.60
20 x $.894 = $17.88 x 12 months =	$214.56
	$668.16	annually

Note:
There will be an additional communications charge if the member chooses not to use the free online ticket reception system provided by USA North.

Call before you dig

811 / 1-800-227-2600

www.usanorth.org

If you have any questions please contact Linda Whitley
1-800-640-5137 ext 2202
lwhitley@usan.org