Safety Council Member Form

The purpose of the CTA Northern and Southern Safety Councils is to provide CTA members’ Safety Professionals with the best possible resources to enhance current and future safety, maintenance processes and technologies, as well as to recognize member companies and drivers for their safety achievements. If you or your company’s safety professional(s) would like to participate in the Northern or Southern Safety Council, please complete the council member profile form below. We are asking that all Safety Council members current and potential fill out the form.

Fields marked with an * are required.

Are you a CTA Member? *

Yes, I am a member.

No, I am not a member but would like information about becoming one.

First Name *

Last Name *

Organization *

Title

Address Line 1

Address Line 2

City

State

Postal Code *

Phone *

Email *

I am currently on the following Safety Council(s)

North

South