Berkshire County District #1
Highway Superintendent’s
Association Inc.

MEMBERSHIP RENEWAL FORM FOR 
2025 

I HEREBY APPLY FOR MEMBERSHIP IN THE FOLLOWING CATEGORY:

$ 50.00* _XXX_ ACTIVE  ( SUPERINTENDENTS , &  THEIR  ASSISTANTS , FOREMEN , STATE AID  PERSONNEL , ENGINEERS, &  ASSOCIATE MEMBERS )

$80.00* _______ SPONSOR (VENDORS, SUPPLIERS & OTHERS)

Please fill in all information requested

NAME: __________________________________________________ DATE: _____________

TITLE: __________________________________________________

EMPLOYER: _____________________________________________

ADDRESS: _______________________________________________

CITY, STATE, & ZIP: __________________________________________________________

PHONE: _________________________ FAX: _________________________________

EMAIL: _______________________________

WEB SITE:______________________________________

APPLICATIONS MAY BE SUBMITTED ALONG WITH YOUR DUES. MAKE YOUR CHECK PAYABLE TO: BERKSHIRE COUNTY HIGHWAY SUPT’S. ASSOC. INC. AND SEND IT TO GERALD M. COPPOLA, SECRETARY
934 WEST HOUSATONIC STREET
PITTSFIELD, MA 01201
Email: berkcountyhwyassoc@yahoo.com 

*NOTICE TO MUNICIPAL EMPLOYEES *
MASSACHUSETTS GENERAL LAWS, CHAPTER 40, SECTION 5, PARAGRAPH 34 STATES THAT THESE DUES AND THE EXPENSES TO ATTEND MEETINGS ARE SUBJECT TO REIMBURSEMENT BY YOUR CITY OR TOWN.