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 be added to all of the mailing lists below

I would like to be on the mailing list for the PSMA newsletter, UPDATE

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

Alternate Representative

Name

Title / Job Function

Telephone

E-mail

Company Info

Indicate membership category

Regular Member (Dues = $1,425)

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 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