For Non-Manufacturers Company InformationCompany Name*Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaRéunionSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Company Phone*Company FaxToll Free PhoneToll Free FaxCompany Email* Company Website Number of EmployeesPrimary BusinessCompany Contact InformationPrimary Contact Name* First Last Job TitlePhoneFaxEmail Membership InformationAny individual, partnership, corporation, or association eligible for membership in more than one category must become a member of the association in the category which is the primary business of the member, or in the higher dues paying category.SHPBA Membership Category*RetailServiceManufacturers RepresentativesAssociatesDistributorsNon-ProfitTotal $0.00 Referred ByPlease electronically sign and dateCondition of eligibility for membership and agree to abide by the bylaws, dues, and membership policies of HPBA. As a result of paying annual membership dues to the Hearth, Patio & Barbecue Association (HPBA) and/or any association affiliated with the HPBA, I certify that we have selected the appropriate membership category, have paid the appropriate level of annual dues for this company and upon request, will provide verification of sales and/or a notarized letter attesting to membership classification and dues category for this company. This company agrees to fully abide by all HPBA membership policies and practices including, but not limited to, all HPBA policies and practices regarding exhibiting at, participating in, and attending HPBA’s Annual Hearth, Patio & Barbecue EXPO, including the following: Events in the nature of an exhibition of products, other than in an EXPO exhibit booth, whether hosted by a vendor or by a retail entity or by a distributor's customer of hearth products, are prohibited at any time during the days of the EXPO education and exhibition. EXPO exhibitors may not have products on display at events attended by their dealers, other than in an EXPO exhibit booth, unless they obtain a variance from HPBA’s EXPO Committee for a very narrow purpose. Manufacturers or other vendors who are not exhibiting at the EXPO also agrees that they will not host events as set forth above at any time during the days of the EXPO education and exhibition. Signature*Date* Date Format: MM slash DD slash YYYY Payment TypePaypalCredit Card* American ExpressDiscoverMasterCardVisa Card Number Month010203040506070809101112 Year20212022202320242025202620272028202920302031203220332034203520362037203820392040 Expiration Date Security Code Cardholder Name