New Member Enrollment

Annual Dues Policy for Membership in Black Swamp Safety Council

The Ohio BWC Safety Council Rebate Program requires annual enrollment in a local safety council by July 31. In order for the Black Swamp Safety Council membership to be accurately reported to BWC, invoices for annual dues will be emailed to members on May 1, and must be paid in full by June 30. If full payment of dues is not received by June 30, BWC will be notified to deactivate company membership.

Dues Structure for Fiscal Year 21 (July 1, 2020 through June 30, 2021)
25 employees or less $90
26 – 50 employees $120
51 – 100 employees $150
101 – 500 employees $210
501 – 1000 employees $270
1001 – 3000 employees $360

New Membership Enrollment Form

Fill out the form below and make your payment online for membership fees!
OR
Download the forms above, fill them out and submit your payment.

Enrollment Date:
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Employer Name:
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Address, City, Zip:
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Phone:
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Email Address:
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Industry Type:
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BWC Policy Number:
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  • Number of Employees:
  • 25 Employees or Less
  • 26 – 50 employees
  • 51 – 100 employees
  • 101 – 500 employees
  • 501 – 1,000 employees
  • 1,001 – 3,000 employees
Number of Employees:
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Printed Name:
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Title:
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Signature:
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By signing and returning this form, you are enrolling your firm as a member of the Black Swamp Safety Council.


Your membership will begin when your application has been returned with a check for your membership.


Please use the Safety Membership Dues Invoice document to figure your member dues.


We look forward to working with you to improve Safety in the workplace.
Signature:
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Date:
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Become a Member Today!