Membership Application Membership LevelPublic Agencies, Industrial Users and Water Suppliers: 1A - Large (300K+ population served) - membership includes 1 primary member and 3 additional 3C affiliate members, $825 1B - Medium (10K-300K population served) - membership includes 1 primary and 2 additional 3C affiliate members, $625 1C - Small (<10K population served) - membership includes 1 primary member and 1 additional 3C affiliate member, $550 1D - Industrial End User - membership includes 1 primary member and 2 additional 3C affiliate members, $550 1E - Regulatory - membership includes 1 primary member and 2 additional 3C affiliate member, $300 Company/Corporate Membership: 2A - Up to 15 Members - membership includes 1 primary member and 14 additional 3D affiliate members, $2,800 2B - Up to 10 Members - membership includes 1 primary member and 9 additional 3D affiliate members, $2,050 2C - Up to 5 Members - membership includes 1 primary member and 4 additional 3D affiliate members, $1,075 2D - Up to 2 Members - membership includes 1 primary member and 1 additional 3D affiliate member, $500Associates: 3A - Individuals, $225 3B - University/College Professors, $200 3C - Additional Affiliate of Div. 1, $200 3D - Additional Affiliate of Div. 2, $200 4 - Students, $0Membership Type*1A - Public Agencies, Industrial Users and Water Suppliers - Large, $8251B - Public Agencies, Industrial Users and Water Suppliers - Medium, $6251C - Public Agencies, Industrial Users and Water Suppliers - Small, $5501D - Industrial End User, $5501E - Regulatory, $3002A - Company/Corporate Membership - Up to 15 Members, $28002B - Company/Corporate Membership - Up to 10 Members, $20502C - Company/Corporate Membership - Up to 5 Members, $10752D - Company/Corporate Membership - Up to 2 Members, $5003A - Individuals, $2253B - University/College Professors, $2003C - Additional Affiliate of Division I Member, $2003D - Additional Affiliate of Division IIB,IIC,orIID Member, $2004 - Students (Full-Time, must submit ID), $0 Ian C. Watson Fellowship for Membrane AdvancementAMTA is seeking donations towards the $10,000 annual Ian C. Watson Fellowship, supporting researchers advancing the understanding, technology, or application of membranes for use in water treatment. Contributions in any amount are appreciated and donors will be recognized on the AMTA website.Click here to Learn More about this fellowship in honor of Ian C. Watson.Interested in donating to the Ian C. Watson Fellowship for Membrane Advancement?Yes, I am interested in donatingNo, I am not interested in donating at this timeConsider helping AMTA with the advancement of membrane technology and offering fellowships to talented university students.Donation AmountDonation of, $100Donation of, $250Donation of, $500Donation of, $1,000Donation of, $10,000Other, Enter AmountEnter Amount How would you like the acknowledgement listed?Your NameCompany NameNo acknowledgement needed Primary MemberSalutation*Mr.Mrs.Ms.Dr.First Name*Middle InitialLast Name*SuffixJob Title* Organization & AddressOrganization*Mailing Address*City*State/Province*ZIP/Postal Code*Country* Contact InformationTelephone*Cell PhoneEmail Address*Enter member's email address Email Address for billing contact*Email address sent to billing contact, if applicable WebsiteNewsletter Printed Version Opt-Out (Foreign & Student Members automatically are enrolled in the Opt-Out)I prefer to receive the Solutions Newsletter electronically and not a printed and mailed copy. Member ProfileInterested in Serving on Committee(s): Awards Historian Legislative/Regulatory Programs Membership Publications/Newsletter 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 Profile Company 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 oneMunicipal Water / WastewaterIndustrial Application - Oil & Gas, Food/Beverage, OtherCheck 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 statusThis full-time student proof must be a letter from the School Registrar’s office of the University or a supporting letter from your University Professor/Advisor indicating that you are currently enrolled as a full-time student and indicating an anticipated graduation date. Part-time students are not eligible for membership. As a condition of receiving a complimentary Div. 4 student membership, you must provide a personal email address and agree to accept email notifications sent from AMTA. A University email address is optional as a second email address and is not an acceptable personal email address. Once you have provided this proof, AMTA will process your membership.Personal Email Address (can not be university email address)* Submit proof of student full time statusAccepted file types: pdf, doc, docx.Total Registration FeeTotal $0.00 Affiliate Member 1Salutation - Affiliate 1MrMrsMsDrFirst Name - Affiliate 1Middle Initial - Affiliate 1Last Name - Affiliate 1Job Title - Affiliate 1Email Address - Affiliate 1Member Bio - Affiliate 1 Affiliate Member 2Salutation - Affiliate 2MrMrsMsDrFirst Name - Affiliate 2Middle Initial - Affiliate 2Last Name - Affiliate 2Job Title - Affiliate 2Email Address - Affiliate 2Member Bio - Affiliate 2 Affiliate Member 3Salutation - Affiliate 3MrMrsMsDrFirst Name - Affiliate 3Middle Initial - Affiliate 3Last Name - Affiliate 3Job Title - Affiliate 3Email Address - Affiliate 3Member Bio - Affiliate 3 Affiliate Member 4Salutation - Affiliate 4MrMrsMsDrFirst Name - Affiliate 4Middle Initial - Affiliate 4Last Name - Affiliate 4Job Title - Affiliate 4Email Address - Affiliate 4Member Bio - Affiliate 4 Affiliate Member 5Salutation - Affiliate 5MrMrsMsDrFirst Name - Affiliate 5Middle Initial - Affiliate 5Last Name - Affiliate 5Job Title - Affiliate 5Email Address - Affiliate 5Member Bio - Affiliate 5 Affiliate Member 6Salutation - Affiliate 6MrMrsMsDrFirst Name - Affiliate 6Middle Initial - Affiliate 6Last Name - Affiliate 6Job Title - Affiliate 6Email Address - Affiliate 6Member Bio - Affiliate 6 Affiliate Member 7Salutation - Affiliate 7MrMrsMsDrFirst Name - Affiliate 7Middle Initial - Affiliate 7Last Name - Affiliate 7Job Title - Affiliate 7Email Address - Affiliate 7Member Bio - Affiliate 7 Affiliate Member 8Salutation - Affiliate 8MrMrsMsDrFirst Name - Affiliate 8Middle Initial - Affiliate 8Last Name - Affiliate 8Job Title - Affiliate 8Email Address - Affiliate 8Member Bio - Affiliate 8 Affiliate Member 9Salutation - Affiliate 9MrMrsMsDrFirst Name - Affiliate 9Middle Initial - Affiliate 9Last Name - Affiliate 9Job Title - Affiliate 9Email Address - Affiliate 9Member Bio - Affiliate 9 Affiliate Member 10Salutation - Affiliate 10MrMrsMsDrFirst Name - Affiliate 10Middle Initial - Affiliate 10Last Name - Affiliate 10Job Title - Affiliate 10Email Address - Affiliate 10Member Bio - Affiliate 10 Affiliate Member 11Salutation - Affiliate 11MrMrsMsDrFirst Name - Affiliate 11Middle Initial - Affiliate 11Last Name - Affiliate 11Job Title - Affiliate 11Email Address - Affiliate 11Member Bio - Affiliate 11 Affiliate Member 12Salutation - Affiliate 12MrMrsMsDrFirst Name - Affiliate 12Middle Initial - Affiliate 12Last Name - Affiliate 12Job Title - Affiliate 12Email Address - Affiliate 12Member Bio - Affiliate 12 Affiliate Member 13Salutation - Affiliate 13MrMrsMsDrFirst Name - Affiliate 13Middle Initial - Affiliate 13Last Name - Affiliate 13Job Title - Affiliate 13Email Address - Affiliate 13Member Bio - Affiliate 13 Affiliate Member 14Salutation - Affiliate 14MrMrsMsDrFirst Name - Affiliate 14Middle Initial - Affiliate 14Last Name - Affiliate 14Job Title - Affiliate 14Email Address - Affiliate 14Member Bio - Affiliate 14 Payment InformationPayment Method*Credit Card - Online PaymenteCheck (Bank Wire w/o processing fee) - Online PaymentCheckInvoiceIf paying by Check, make payable to American Membrane Technology Association, and mail to 2409 SE Dixie Hwy., Stuart, FL 34996. Comments & CaptchaIf you would like a copy of the invoice/receipt sent to another*Yes, send copy of invoice/receipt to:No, don't need a copy sentIf yes, you would like a copy of the invoice/receipt sent to another other than the attendee please enter information below.Name* First Last Email Address* Questions/CommentsCaptchaPlease refer to AMTA’s Privacy Policy if you have any questions regarding your preferences.