Application Form | Advanced Photonics Coalition

Membership Request Form

Membership term is for one year from the date APC confirms the membership in writing.

APC is a not-for-profit membership corporation incorporated in the state of Washington and has applied for exemption from taxation in the United States under Internal Revenue Service Code Section 501(c)6.

Please Indicate Membership Category

Steering ($15,000)

Associate ($9,500)

Start-Up Associate - Less than $5M in Revenue ($5,000)

Are you a subsidiary or affiliate of any other company? If so, please identify:

Name

Were you invited to join by a Director of the Board? If so, please identify:

Company

Position

Street Address

City

Region/State/Province

Postal / Zip code

Phone Number

Web Site

Alternate Representative

Title

Billing Contact

Title

Phone Number

By submitting this application to the Advanced Photonics Coalition, the Applicant agrees that, if accepted, it will (i) pay the Membership dues and fees as determined from time to time by the Board of Directors and (ii) comply with all the terms and conditions of APC's Articles of Incorporation, Bylaws, and policies adopted by the Board of Directors.

This application may be withdrawn by Applicant at any time prior to acceptance by providing written notice to APC. If Applicant’s membership is terminated for any reason, Applicant acknowledges that fees due or paid for any remaining months of an annual membership period will not be refunded.

All legal and financial notices from APC will be sent via e-mail to Applicant’s Primary Representative unless APC is directed otherwise in writing.

By signing this document, you represent that you are authorized to make this application on behalf of the organization and agree to the terms and conditions set forth above.

Application status is delivered in 24 hours.

For Associate Members outside North America, the one time fee is $150.

For Associate Members in North America, the one time fee is $125.

Digital Signature