Application for Membership of the Ground Source Heat Pump Association
1)Contact Details:Business name: / Registered number:
Contact name: / Position within organisation:
Business address: / Invoice address:(if different)
Telephone: / Mobile:
Website: / Email:
One of the many benefits of becoming a member of the GSHPA is you gain a direct link to your own website from GSHPA and you may use the GSHPA logo on your website and in your promotional materials.
2)Membership Offer:
Please select the membership offer you require:
Membership offer: / Tick:
Annual membership
Promotional Offer: 6 months free trial*
* Promotional Offer: 6 months free trial. This membership offer entitles you to enjoy the benefits of being a full GSHPA member for free for 6 months. After this period you will be charged according to the membership category in the next section of this form, for a further 12 months of full membership at the advertised rate. You will not be billed until your free trial ends. You may cancel at any time during your free trial period.
3)Membership Type:
Please select the membership type you wish to apply for:
For clarification of these membership categories and their associated benefits, please refer to ‘Annual Subscriptions’, which can be found at:
1)Trade Membership: / Tick: / Annual Fee: (excl. VAT)
Sponsoring Organisation / £5,000
Very Large Company (> 100 employees) / £2,500
Large Company (51-100 employees) / £2,000
Big Company (26-50 employees) / £1,500
Medium Company (11-25 employees) / £1,000
Small Medium Company (6-10 employees) / £580
Small Company (2-5 employees) / £460
Sole Trader / £250
2)Associate Membership: / Tick: / Annual Fee:
Ancillary Company / £360
Not for Profit / Charity / £140
Individual / Student / £60 (Student £20)
4)Category:
Please select one category that best defines you or your organisation seeking membership:
Category: / Tick:
A / Large scale Installer
B / Domestic / Installer
C / Manufacturer / Supplier / Distributor
D / Driller
E / Consultant / Project Management
F / Trade Association
G / End user
H / Other: Please Specify
5)Accreditation: To be completed by Installers
Are you accredited for ground source under the Microgeneration Certification Scheme (MCS)? Please tick one option.
Yes: / In Progress: / No:
If ‘yes’ please supply the MCS Number ______.
If ‘In Progress’ or ‘No’ please supply two references for GSHP installations you have completed in the last 12 months:
Reference 1:
Date of install:
Customer name:
Customer telephone:
Customer email:
Description of project:
/ Reference 2:
Date of install:
Customer name:
Customer telephone:
Customer email:
Description of project:
6)Standards & Codes of Practice:
Please confirm that you have read and accept the following documents:
Statement: / Tick:
I / my company shall abide by the GSHPAs Code of Ethical Practice:
I / my company confirm all of the heat pumps (or systems) that we supply are in accordance withGSHPA Standards andMIS 3005:
I / my company shall abide by the Articles of Association as set out by the GSHPA:
7)Referrals:
Are you applying on the recommendation of an existing member of the GSHPA?
Yes:
No:
If yes, please provide their details below so we can say thank you and reward them for their recommendation:
Full name: / Company name:
8)Agreement:
Please confirm you have read and agree to the following statement:
Tick:
I agree
On behalf of the business that I represent, I confirm that all of the information supplied on this form is completeand correct.I acknowledge that the information I have supplied shall be used in accordance with the Data Protection Act 1998, and that my details will be used by the GSHPA and its members for marketing purposes related to the GSHP Association, and shall not be passed to third parties.
9)Promotional Offer Payment: To be completed by 6 month Free Trial applicants only
In order to process your 6 month free trial we require your bank details. No payment will be taken until your free trial ends.
This membership offer entitles you to enjoy the benefits of being a full paying GSHPA member for free for six months. After this period you will be charged according to the membership type you selected in section 3 of this form, for a further 12 months of full membership at the advertised rate. You will not be billed until your free trial ends. You may cancel at any time during your free trial period.
Bank:
Account Name:
Account Number:
Sort Code:
Bank details:
10)Payment: To be completed by Annual Member applicants only
In order to process your membership application,please select your preferred method of payment:
Payment Option: / Tick:
Pay now via bank transfer to:
NEF account 37399543
Sort Code 60-14-55
Ref GSHPA + your name.
Set up standing order
By selecting this option an annual payment will be deducted from your specified account for your membership.
Pay via cheque
Please print off and return this completed application form with a cheque for your selected membership type, made payable to the ‘Ground Source Heat Pump Association’.Please kindly return this form to: The Membership Secretary, GSHPA at the address below.
Thank you for choosing to join the Ground Source Heat Pump Association
Upon the successful submission of your application, the Secretariat will confirm your membership and provide a Welcome Pack, complete with your login details for the members section of the website you have any questions in the meantime, please contact the Association:
Email: lephone: 01908 354545 Ground Source Heat Pump Association
National Energy Centre
Davy Avenue
Knowlhill
Milton Keynes, MK5 8NG