Renew COESRA Membership
Promote COESRA Membership to Employees
General Membership - $150
Vendor Membership - $250
Individual Membership - $25
Community Service Membership - $50
Address Line 2
District of Columbia
Armed Forces Americas
Armed Forces Europe
Armed Forces Pacific
Total Number of Employees
Please enter a number from
Additional Representative (Optional)
Business Information + Referral
Date Business Began
(Must have been in business for one (1) year and hold a valid business license)
Two local Business References
(companies that are currently utilizing your services or buying your products - please provide name and phone)
Nature of Your Business
Type of Business
Other (describe above)
By what means do you distribute information to your employees
How did you hear about us? If via business referral, please provide.
What special discount program would your company provide for chapter members?
Is a similar discount extended to companies other than ESMSNV members? If yes, please specify.
Vendor memberships are tentatively approved but
not finalized until the Board has reviewed and approved the business and discount program
: The Board reserves the right to limit the number of Vendor members in some of the same or similar industries, i.e. Employment Agencies, Real Estate Agencies, Financial Planners, Insurance Agencies, and others as determined by the Board in order to preserve the value of the memberships.
You will have the option to pay online or mail your payment upon submission of this form. For your records, a copy of this form will be sent to the email address indicated above. Please direct any questions to
Credit Card Online
Check by Mail
Community Service Membership
Your Membership Key
COESRA reserves the right to approve or deny any membership application or renewal. All memberships are for a rolling 12-month period.
Disclaimer: Participation is strictly voluntary and participants assume all risks of participating in meetings, programs, activities or events. Participants will be required to sign COESRA’s Accident Waiver and Release of Liability form at all functions. COESRA is not responsible for employee services/discount programs, and member companies and their employees assume all risks when accessing these programs.
COESRA is a non-profit association of leading business, industry and government organizations dedicated to the advancement of employee services management programs which are an integral part of sound business management.