Document pBvD9qewk90jZ0Ex8gR4b7rRa

FILE NAME: National Safety Council (NSC) DATE: 1978 DOC#: NSC100 DOCUMENT DESCRIPTION: NSC - Annual Renewal Application for Potomac Electric Power ANNUAL MLMBfcRSHiP REVIEW FOR: ------------------------------------- s National Safety Council 444 NORTH MICHIGAN AVENUE CHICAGO. ILLINOIS 60611 POTOMAC ELECTRIC POWER HUMAN RESOURCES HLTH & SAF DEP 1900 PENNSYLVANIA AVE NW WASHINGTON D C ' 20066 0 004 426 TYPE OF MEMBERSHIP EMPLOYER J V _________________________________ MEMBER N U M B E R : 0 3 3 0 3 0 - 0 0 0 - 3 TYPE OF SERVICE NSC SECTION (se* raiMwai guide) AFFILIATION DATE Mo Year CURRENT EXPIRATION Mo. Day Veer OPTIONAL P8L 06 36 06 30 78 RENEWAL INSTRUCTIONS STEP 1. Please fill in red blanks and boxes. STEP 2. Review the attached Service Mailing List. Corrections, additions, and deletions shoud be printed or typed on the Service Mailing List form. STEP 3. Be sure to add the Zip code number following the state for each address to which materials r will be mailed. MEMBERSHIP COVERAGE Check here if all your organization's locations are included in the membership. Please list the names of subsidiaries, and branches in the spaces below (or attach list) if: 1. The location does not appear on the attached Service Mailing List, or 2. The location name is different from your company name. Note: Insurance members need not list locations. NAME ADDRESS CITY P LA IN T IF F 'S me-i r EXHIBIT STATE ZIP NO MEMBERSHIP DUES Please refer to the Table of Annual Dues in the accompanying Membership Renewal Guide to determine the amount of annual dues. Show the basis for dues specified for your form of mem bership in Box A, and the dues amount in Box B, Below: DUES BASIS -- USE APPROPRIATE BOX TOTAL NUMBER OF EMPLOYEES 7 o OR TOTAL PREMIUM IN CO M E r: Dues in payment for annual membership ser vices supplied by the National Safety Council are an appropriate tax deductible business ex pense. The Council also urges tax deductible contributions to the Trustees Fund in support of its off-the-job safety programs. OR y TOTAL NUMBER OF SCHOOL BUS DRIVERS NSC FORM 50 ANNUAL REVIEW-RETURN TO NATL. SAFETY COUNCIL f t EASE FILL IN ANNU AL DUES % 8o5.oo 7 (date/ ' r " O R M 52 National Safety Council 04 14 76 SERVICE MAILING LISI M EM BER NC 033030-000- IF ANY CHANGES ARE NECESSARY, PLEA S E INDICATE ON THIS U S T AND RETURN TO NSC. MATERIALS PROVIDED WITHOUT ADDITIONAL C H A R G E AS PA RT O F YOUR M EM B ER S -ERVIC E ARE INDICATED BY AN ASTERISK. PERIODICALS AND O THER MATERIALS WHICH ARE PART O F A "SAFETY M ATERIAL SERVICE" ARE N O T LISTED. SEE SUBSCRIPTION PRJC <7 FO R PUBLICATIONS INCLUDED IN "SA FETY MATERIAL SERVICES.* CONTACT NO. Q U A N TITY LOCATION AND MATERIALS 001 3 002 3 POTOMAC ELECTRIC POWER HUMAN RESOURCES HLTH & SAF DEP 1900 PENNSYLVANIA AVE NW WASHINGTON D C 20068 1 SFY MAT SER Al PBL 7 NATL SFY NEWS 12 ISSUES 1 NEWSLETTER CONSTRUCTION CNS l TRAFFIC SAFETY SUBS POTOMAC ELECTRIC POWER MEDICAL DEPARTMENT 1900 PENNSYLVANIA AVE NW WASHINGTON D C 20068 1 NEWSLETTER OCCUP HLT NRS 0CC 00220 0000 11101 oooo 11201 0008 31101 0000 06/78 05 06/78 05 06/78 05 06/78 05 11201 0032 06/78 05