PSMA Membership Application

Company Name

Company Representative

Name

Title / Job Function

Address

City

State / Province

Postal Code

Country

Telephone

Fax

E-mail

I would like to receive invitations for upcoming PSMA Power Technology Roadmap and educational webinars

I would like to receive information on upcoming PSMA sponsored conferences, workshops and other events

I would like to receive emails about events and opportunities of interest to PSMA members

I would like to receive weekly activity updates on Efficiency Regulations monitored by the PSMA Energy Efficiency Data Base

I would like to receive activity updates on Standards monitored by the PSMA Safety and Compliance Data Base.

All of the above

None of the above

Alternate Representative

Name

Title / Job Function

Telephone

E-mail

Company Info

Indicate membership category

Regular Member (Dues = $1,425)

Associate Member (Dues = $1140

Affiliate Member (Dues = $190)

Affiliate - Education (Dues = $190, Dues may be waived for qualified persons, institutions or companies.)

(Please note that a one time processing fee of $50 applies to all membership categories for companies in North America. For Regular and Associate Members outside North America the one time fee is $100, and for Affiliate Members outside North America the one time fee is $75.)

Brief description of Company

Type of business

Type of products

Web site

Primary Markets

Subsidiary companies covered under membership

How did you hear of the PSMA

PSMA website/newsletter

Other website/blog (Please specify below)

Colleague (Please specify below)

Publication (Please specify below)

Other (Please specify below)

Code (optional)

I have read and accept the PSMA Privacy Policy

PSMA Privacy Policy

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