NIMA Membership Application

MEMBERSHIP APPLICATION

To apply for membership, please complete all questions.
Organization Name*
As you would like it to appear on membership roster.
Organization Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Organization Website*
Years in Business*
Number of Employees*
Industries Served (Check all that Apply)*

AerospaceSpaceDefenseMedical/BiotechEnergyPrecision Industrial EquipmentOther
Brief Description of your Organization's Products and/or Services*
This will be used in your membership profile.
Organization Logo

This will be used in your membership profile.
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Primary Contact Name*

First NameLast Name
Primary Contact Email*
example@example.com
Primary Contact Work*
Please enter a valid phone number.
Primary Contact Cell
Please enter a valid phone number.
HR Contact Name (if different than above)

First NameLast Name
HR Contact Email
example@example.com
HR Contact Phone Number
Please enter a valid phone number.
Billing Address

Use the address above.I want to specify a different billing address.
Billing Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Membership Type (Annual Dues)*
prevnext( X )
Enterprise
>200 Employees

$2,500



Large
101-200 Employees

$1,500



Medium
51-100 Employees

$1,000



Small
21-50 Employees

$750



Micro
1-20 Employees

$500



Affiliate
Education, EDC, Government, Peer Association Organizations

$250
Date of Application*

MonthDayYear
Date
Should be Empty:

MEMBERSHIP APPLICATION