2024 New Membership Registration Form Membership Type* 1A – Public Agencies, Industrial Users and Water Suppliers – Large, $525 1B – Public Agencies, Industrial Users and Water Suppliers – Medium, $465 1C – Public Agencies, Industrial Users and Water Suppliers – Small, $405 1D – Industrial End User, $600 1E – Regulatory, $325 2A – Company/Corporate Membership – Up to 15 Members, $2,975 2B – Company/Corporate Membership – Up to 10 Members, $2,100 2C – Company/Corporate Membership – Up to 5 Members, $1,200 2D – Company/Corporate Membership – 2 Members, $440 2D – Company/Corporate Membership – 1 Member, $295 3A – Individuals, $225 3B – University/College Professors, $200 4 – Students (Full-Time), $0 5 – Recent Graduate, $50 Primary MemberSalutation*Mr.Mrs.Ms.Dr.First Name* Middle Initial Last Name* Suffix Job Title* Organization & AddressOrganization* Mailing Address* City* State/Province*Not Applicable, InternationalALAKAZARCACOCTDCDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYZIP/Postal Code* Country*USAAfghanistanĂ…land IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCĂ´te d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRĂ©unionRomaniaRussiaRwandaSaint BarthĂ©lemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweContact InformationTelephone* Cell Phone Email Address*Enter member’s email address Individual Social Media UsernamesLinkedIn Twitter Company/Organization Social Media UsernamesLinkedIn Twitter Website Billing Contact InformationEnter billing contact information, if applicableBilling Contact Name Billing Contact EmailEmail address sent to billing contact, if applicable Billing Contact Phone Please send copy of the invoice/receipt to Billing Contact Please complete the linked spreadsheet to provide additional members or additional entity names that you wish to be associated with your Division 2 Membership. Download the file here The completed spreadsheet should be emailed to AMTA Staff Member ProfileInterested in Serving on Committee(s): Awards Fellowships Historian Legislative/Regulatory Programs Membership Communications Student and Young Professionals (SYP) Technology Transfer Interested in the following: Running for position on AMTA Board Presenting at a Workshop or Conference Member BioCompany ProfileCompany ProfileInstructions: if you are applying for a Division 1 or 2 Membership, please check all the categories that apply to your company and what you offer so that when a search is done for those products or services, your company will be listed.1. Membrane Element / Module Component Manufacturer Membrane Element / Module Component Manufacturers Check all the apply Electrodialysis, ED & Electrodialysis Reversal, EDR Forward Osmosis, FO Membrane Bioreactor, MBR Microfiltration, MF Reverse Osmosis, RO / Nanofiltration, NF Ultrafiltration, UF 2. Membrane System Manufacturer / Supplier Membrane System Manufacturer / Supplier 3. Membrane System Component Supplier Membrane System Component Supplier Check all that apply Pumps Pressure Vessels Instrumentation / SCADA Valves & Fittings Controls Energy Recovery Other 4. Membrane System Architect / Engineer / Consultant Membrane System Architect / Engineer / Consultant 5. Membrane System Process Integrator Membrane System Process Integrator 6. Membrane System Chemical Supplier Membrane System Chemical Supplier 7. Membrane System Troubleshooting / Laboratory Support Membrane System Troubleshooting / Laboratory Support 8. Membrane System Manager / System Operator Membrane System Manager / System Operator Choose one Municipal Water / Wastewater Industrial Application – Oil & Gas, Food/Beverage, Other Check all that apply Electrodialysis, ED & Electrodialysis Reversal, EDR Forward Osmosis, FO Membrane Bioreactor, MBR Microfiltration, MF Reverse Osmosis, RO/ Nanofiltration, NF Ultrafiltration, UF 9. Membrane System Research Center / University Membrane System Research Center / University Please provide proof of your full time student status or proof of the two-year post graduation periodFull-time student proof must be a letter from the University Registrar’s office or a supporting letter from your University Professor/Advisor indicating that you are currently enrolled as a full-time student that includes an anticipated graduation date. Part-time students are not eligible for the student membership. As a condition of receiving a complimentary Div. 4 student membership, you must also provide a personal email address. Once you have provided this proof, AMTA will process your membership. Proof of full-time student status must be provided annually.Personal Email Address (can not be university email address)* Submit proof of full time student status: Student ID will not be accepted as proof.*Accepted file types: pdf, doc, docx, Max. file size: 100 MB.Submit proof that you are a recent graduate: Requires final transcript or copy of degree*Accepted file types: pdf, doc, docx, Max. file size: 100 MB.What is your anticipated year of graduation?*2021202220232024202520262027202820292030What year did you graduate?*202120222023Total Registration FeeTotal $0.00 HiddenAffiliate Member 1HiddenSalutation – Affiliate 1MrMrsMsDrHiddenFirst Name – Affiliate 1 HiddenMiddle Initial – Affiliate 1 HiddenLast Name – Affiliate 1 HiddenJob Title – Affiliate 1 HiddenEmail Address – Affiliate 1 HiddenTelephone – Affiliate 1 HiddenCell Phone – Affiliate 1 HiddenMember Bio – Affiliate 1HiddenAffiliate Member 2HiddenSalutation – Affiliate 2MrMrsMsDrHiddenFirst Name – Affiliate 2 HiddenMiddle Initial – Affiliate 2 HiddenLast Name – Affiliate 2 HiddenJob Title – Affiliate 2 HiddenEmail Address – Affiliate 2 HiddenTelephone – Affiliate 2 HiddenCell Phone – Affiliate 2 HiddenMember Bio – Affiliate 2HiddenAffiliate Member 3HiddenSalutation – Affiliate 3MrMrsMsDrHiddenFirst Name – Affiliate 3 HiddenMiddle Initial – Affiliate 3 HiddenLast Name – Affiliate 3 HiddenJob Title – Affiliate 3 HiddenEmail Address – Affiliate 3 HiddenTelephone – Affiliate 3 HiddenCell Phone – Affiliate 3 HiddenMember Bio – Affiliate 3HiddenAffiliate Member 4HiddenSalutation – Affiliate 4MrMrsMsDrHiddenFirst Name – Affiliate 4 HiddenMiddle Initial – Affiliate 4 HiddenLast Name – Affiliate 4 HiddenJob Title – Affiliate 4 HiddenEmail Address – Affiliate 4 HiddenTelephone – Affiliate 4 HiddenCell Phone – Affiliate 4 HiddenMember Bio – Affiliate 4HiddenAffiliate Member 5HiddenSalutation – Affiliate 5MrMrsMsDrHiddenFirst Name – Affiliate 5 HiddenMiddle Initial – Affiliate 5 HiddenLast Name – Affiliate 5 HiddenJob Title – Affiliate 5 HiddenEmail Address – Affiliate 5 HiddenTelephone – Affiliate 5 HiddenCell Phone – Affiliate 5 HiddenMember Bio – Affiliate 5HiddenAffiliate Member 6HiddenSalutation – Affiliate 6MrMrsMsDrHiddenFirst Name – Affiliate 6 HiddenMiddle Initial – Affiliate 6 HiddenLast Name – Affiliate 6 HiddenJob Title – Affiliate 6 HiddenEmail Address – Affiliate 6 HiddenTelephone – Affiliate 6 HiddenCell Phone – Affiliate 6 HiddenMember Bio – Affiliate 6HiddenAffiliate Member 7HiddenSalutation – Affiliate 7MrMrsMsDrHiddenFirst Name – Affiliate 7 HiddenMiddle Initial – Affiliate 7 HiddenLast Name – Affiliate 7 HiddenJob Title – Affiliate 7 HiddenEmail Address – Affiliate 7 HiddenTelephone – Affiliate 7 HiddenCell Phone – Affiliate 7 HiddenMember Bio – Affiliate 7HiddenAffiliate Member 8HiddenSalutation – Affiliate 8MrMrsMsDrHiddenFirst Name – Affiliate 8 HiddenMiddle Initial – Affiliate 8 HiddenLast Name – Affiliate 8 HiddenJob Title – Affiliate 8 HiddenEmail Address – Affiliate 8 HiddenTelephone – Affiliate 8 HiddenCell Phone – Affiliate 8 HiddenMember Bio – Affiliate 8HiddenAffiliate Member 9HiddenSalutation – Affiliate 9MrMrsMsDrHiddenFirst Name – Affiliate 9 HiddenMiddle Initial – Affiliate 9 HiddenLast Name – Affiliate 9 HiddenJob Title – Affiliate 9 HiddenEmail Address – Affiliate 9 HiddenTelephone – Affiliate 9 HiddenCell Phone – Affiliate 9 HiddenMember Bio – Affiliate 9HiddenAffiliate Member 10HiddenSalutation – Affiliate 10MrMrsMsDrHiddenFirst Name – Affiliate 10 HiddenMiddle Initial – Affiliate 10 HiddenLast Name – Affiliate 10 HiddenJob Title – Affiliate 10 HiddenEmail Address – Affiliate 10 HiddenTelephone – Affiliate 10 HiddenCell Phone – Affiliate 10 HiddenMember Bio – Affiliate 10HiddenAffiliate Member 11HiddenSalutation – Affiliate 11MrMrsMsDrHiddenFirst Name – Affiliate 11 HiddenMiddle Initial – Affiliate 11 HiddenLast Name – Affiliate 11 HiddenJob Title – Affiliate 11 HiddenEmail Address – Affiliate 11 HiddenTelephone – Affiliate 11 HiddenCell Phone – Affiliate 11 HiddenMember Bio – Affiliate 11HiddenAffiliate Member 12HiddenSalutation – Affiliate 12MrMrsMsDrHiddenFirst Name – Affiliate 12 HiddenMiddle Initial – Affiliate 12 HiddenLast Name – Affiliate 12 HiddenJob Title – Affiliate 12 HiddenEmail Address – Affiliate 12 HiddenTelephone – Affiliate 12 HiddenCell Phone – Affiliate 12 HiddenMember Bio – Affiliate 12HiddenAffiliate Member 13HiddenSalutation – Affiliate 13MrMrsMsDrHiddenFirst Name – Affiliate 13 HiddenMiddle Initial – Affiliate 13 HiddenLast Name – Affiliate 13 HiddenJob Title – Affiliate 13 HiddenEmail Address – Affiliate 13 HiddenTelephone – Affiliate 13 HiddenCell Phone – Affiliate 13 HiddenMember Bio – Affiliate 13HiddenAffiliate Member 14HiddenSalutation – Affiliate 14MrMrsMsDrHiddenFirst Name – Affiliate 14 HiddenMiddle Initial – Affiliate 14 HiddenLast Name – Affiliate 14 HiddenJob Title – Affiliate 14 HiddenEmail Address – Affiliate 14 HiddenTelephone – Affiliate 14 HiddenCell Phone – Affiliate 14 HiddenMember Bio – Affiliate 14Payment InformationPayment Method* Invoice Once a membership application has been received, AMTA will send you a PDF invoice for your membership, which will include a link to make payment.Comments & CaptchaQuestions/CommentsCAPTCHAPlease refer to AMTA’s Privacy Policy if you have any questions regarding your preferences.American Membrane Technology Association is a Section 501(c)(4) organization. Because 5% of all membership dues collected is used for advocacy and legislative activities, 5% of each paid membership dues is not eligible as a business expense for federal and state income tax purposes.