Please print and fill out the application for membership. Please mail to the address shown on the application and enclose a check for your membership fee.
Massachusetts Chimney Sweep Guild
Application for Membership
Applicant Name: __________________________________________
Company Name: __________________________________________
Mailing Address: __________________________________________
Work Phone: __________________________________________
Home Phone: __________________________________________
Cellular Phone: __________________________________________
Membership Status: (Membership runs from January 1st to December 31st.)
(please circle one) Sweep Out-of-State Sweep Associate
Sweep Membership Dues are $150. Any member company doing business in the Commonwealth of Massachusetts that evaluates, repairs and / or sweeps chimneys is considered a Sweep Member and holds full voting rights.
Out-of-State Sweep Membership Dues are $150. Any member company doing business outside of the Commonwealth of Massachusetts that evaluates, repairs and / or sweeps chimneys is considered a Sweep member and holds full voting rights.
Associate Membership Dues are $150. Any member company that manufacturers and / or supplies materials or components to the sweeping trade is considered an Associate member. Associate members have no election or ballot question voting rights.
(please circle one) New Member or Renewal (was a member last year) or Returning Previous Member
(please check only one of the folowing and attach any required additional paperwork)
__________ Use Towns Serviced List from Last Year (no town list required)
__________ Add the following Additional Towns to Last Years List (list to be attached)
__________ Remove the following Towns from Last Years List (list to be attached)
__________ New Town List (attach the Official MCSG Towns Serviced List) - Only required for new or returning previous members
Membership Dues enclosed: $__________ Optional tax deductible donation to the MCSG enclosed: $__________
For full 2017 membership benefits and listing, applications are due by December 10, 2016 (applications can be sent in after the due date)
Please make check payable to: Massachusetts Chimney Sweep Guild
Mail your check, fully completed and signed application to: David Hannah 582 Pleasant St. Apt. 1M, Holyoke, MA. 01040
If you have any questions, please contact David Hannah Phone: (217) 685-8844 Email: email@example.com
Membership Eligibility Requirements:
Questions 1-7 are not required for either an Out of State Sweep (unless performing chimney work in the state of Massachusetts)
or an Associate Membership.
All applicants must sign and date the application at the bottom!
New (never enrolled as a member before) sweep memberships have a one calendar year grace period to fulfill the eligibility requirements; they will be considered (unlisted or listed as) a prospective member until the eligibility requirements have been met. They must enclose a request letter asking for a grace period from the board of directors.
All “Sweep” memberships must have line numbers 1 through 4 completely filled out to be eligible for membership.
Incomplete applications will be denied and returned. (Unless requesting a "grace period" see paragraph above.)
1. CSIA, MCSG or CCP Certification # __________ Name ____________________________________ Current (yes or no) __________
(MCSG Certification / Equivalency Testing is a free option to applicants and must be re-taken every two years.)
If your CSIA certification is not current, did you have your certification for 10 or more years (yes or no) __________
If your CSIA certification is not current you are required to enter your valid MA CSL number on line #5
2. Enter your required liability policy # (& enclose or email a certificate of insurance) ____________________________________
3. Enter your MA required workman’s comp. policy # (& enclose or email a certificate of insurance) _________________
or initial here ______________ I certify that I am exempt from having worker’s comp. insurance as I am a sole proprietor with absolutely no employees (no
relatives working for me either).
4. Enter your MA required MA HIC# ____________________ Name ______________________________
or initial here ______________ I certify that I am exempt from having an HIC Registration as I never, under any circumstance have an invoice over $1000 and I
never hire subcontractors.
The following optional questions will affect how your company is listed by the MCSG: “Sweeping Only Co.” or a “Sweeping
and Repair Co.”. Also if you omit an answer to # 5, you must not be advertising any type of "repair" work.
5. Enter your MA required MA CSL# ____________________ Name ______________________________
(Please attach another sheet for any other CSL’s you would like posted as a “job site foreman”.)
6. Do you work on public property on bids valued over $10,000 ?
No __________ If no, you are done with the eligibility portion, skip step #7 and proceed below.
7. Enter your MA required OSHA 10 # ____________________ Name _____________________________
The Massachusetts Chimney Sweep Guild Code of Ethics:
I accept and acknowledge that membership in the Massachusetts Chimney Sweep Guild carries with it certain responsibilities and obligations. In this regard, all in my firm and I pledge the following:
I accept the responsibility of cultivating by perception and example in my service community the enlightened use of solid-fuel heating appliances and of developing in my clients as well as the general public a respect for safety in the installation, operation and maintenance of all combustion appliances and their venting systems.
I agree to conduct business in a decent, respectful and professional manner and to continually update and expand the knowledge, skill and technique of myself and of my entire staff.
I agree to run my company in compliance with all codes and regulations applicable to the chimney industry in our service areas and I agree to clean and inspect chimneys by the professional standards set for the chimney industry in NFPA 211.
I accept my role as a well informed and articulate professional. I agree to represent my company in an honest and fair manner, refrain from engaging in deceptive practices or making any deceptive statements and will admit openly when I am unsure of the proper course to follow. I endeavor to develop a respect for precision and accuracy in performing my duties and to ensure to the best of my knowledge and ability that all I have claimed to do has been done.
I endorse the use of liability insurance to assure protection for my clients, my business and myself.
I dedicate myself to these principles, confident in the belief that professionalism and honesty ultimately will prevail in the free marketplace. I understand that failure to abide by these ethical obligations is a violation of MCSG policy and may result in disciplinary action. I agree to hold harmless the MCSG organization and its officers from any liability including but not limited to liability resulting from any disciplinary and or legal action taken against me and or my company.
Signed: ____________________________________________________________________________________ Date: ________________________________________
Official MCSG Towns Serviced List
Below, place a number in front of each town you service, in order of importance
(1 being your most important town).
No two towns can have the same number.
The towns you service will be listed for you on our website
to direct people to the appropriate MCSG members