Membership Application 2023 AMTA Membership Application Membership LevelPublic Agencies, Industrial Users and Water Suppliers: 1A - Large (300K+ population served) - membership includes 1 primary member and 4 additional 3C affiliate members $825 1B - Medium (10K-300K population served) - membership includes 1 primary and 3 additional 3C affiliate members $625 1C - Small (<10K population served) - membership includes 1 primary member and 2 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 (requires documentation showing full time status) $0 5 - Recent Graduate from Accredited Program (eligible for 2 years after receiving degree - requires final transcript or copy of degree) $50Membership Type* 1A - Public Agencies, Industrial Users and Water Suppliers - Large, $825 1B - Public Agencies, Industrial Users and Water Suppliers - Medium, $625 1C - Public Agencies, Industrial Users and Water Suppliers - Small, $550 1D - Industrial End User, $550 1E - Regulatory, $300 2A - Company/Corporate Membership - Up to 15 Members, $2800 2B - Company/Corporate Membership - Up to 10 Members, $2050 2C - Company/Corporate Membership - Up to 5 Members, $1075 2D - Company/Corporate Membership - Up to 2 Members, $500 3A - Individuals, $225 3B - University/College Professors, $200 3C - Additional Affiliate of Division 1 Member, $200 3D - Additional Affiliate of Division 2B, 2C,or 2D Member, $200 4 - Students (Full-Time, must submit supporting documentation), $0 5 - Recent Graduate (must provide supporting documentation), $50 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. 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?Consider helping AMTA with the advancement of membrane technology and offering fellowships to talented university students. Yes, I am interested in donating No, I am not interested in donating at this time Donation Amount Donation of $100 Donation of $250 Donation of $500 Donation of $1,000 Donation of $10,000 Other Enter Amount American Membrane Technology Association is a Section 501(c)(4) organization, gifts and donations to which are not deductible as charitable contributions for federal or state income tax purposes.Enter Amount How would you like the acknowledgement listed? Your Name Company Name No acknowledgement needed 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*USAAfghanistanÅland 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 RicaCôte 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 RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint 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 SaharaYemenZambiaZimbabwe Contact InformationTelephone* Cell Phone Email Address*Enter member's email address Individual Social Media UsernamesLinkedIn Twitter Website Company/Organization Social Media UsernamesLinkedIn Twitter HiddenFacebook HiddenNewsletter Printed Version Opt-InAMTA’s quarterly newsletter, Solutions, is published electronically to reduce waste and save resources. Opt-in to receive a print copy (not available to foreign & student members). I prefer to receive a print copy of Solutions as well as an electronic copy. 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 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 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 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 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 will not be accepted as 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. Proof of two-year post graduation requires a final transcript that shows graduation date.*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 Affiliate Member 1Salutation - Affiliate 1MrMrsMsDrFirst Name - Affiliate 1 Middle Initial - Affiliate 1 Last Name - Affiliate 1 Job Title - Affiliate 1 Email Address - Affiliate 1 Telephone - Affiliate 1 Cell Phone - Affiliate 1 Member Bio - Affiliate 1 Affiliate Member 2Salutation - Affiliate 2MrMrsMsDrFirst Name - Affiliate 2 Middle Initial - Affiliate 2 Last Name - Affiliate 2 Job Title - Affiliate 2 Email Address - Affiliate 2 Telephone - Affiliate 2 Cell Phone - Affiliate 2 Member Bio - Affiliate 2 Affiliate Member 3Salutation - Affiliate 3MrMrsMsDrFirst Name - Affiliate 3 Middle Initial - Affiliate 3 Last Name - Affiliate 3 Job Title - Affiliate 3 Email Address - Affiliate 3 Telephone - Affiliate 3 Cell Phone - Affiliate 3 Member Bio - Affiliate 3 Affiliate Member 4Salutation - Affiliate 4MrMrsMsDrFirst Name - Affiliate 4 Middle Initial - Affiliate 4 Last Name - Affiliate 4 Job Title - Affiliate 4 Email Address - Affiliate 4 Telephone - Affiliate 4 Cell Phone - Affiliate 4 Member Bio - Affiliate 4 Affiliate Member 5Salutation - Affiliate 5MrMrsMsDrFirst Name - Affiliate 5 Middle Initial - Affiliate 5 Last Name - Affiliate 5 Job Title - Affiliate 5 Email Address - Affiliate 5 Telephone - Affiliate 5 Cell Phone - Affiliate 5 Member Bio - Affiliate 5 Affiliate Member 6Salutation - Affiliate 6MrMrsMsDrFirst Name - Affiliate 6 Middle Initial - Affiliate 6 Last Name - Affiliate 6 Job Title - Affiliate 6 Email Address - Affiliate 6 Telephone - Affiliate 6 Cell Phone - Affiliate 6 Member Bio - Affiliate 6 Affiliate Member 7Salutation - Affiliate 7MrMrsMsDrFirst Name - Affiliate 7 Middle Initial - Affiliate 7 Last Name - Affiliate 7 Job Title - Affiliate 7 Email Address - Affiliate 7 Telephone - Affiliate 7 Cell Phone - Affiliate 7 Member Bio - Affiliate 7 Affiliate Member 8Salutation - Affiliate 8MrMrsMsDrFirst Name - Affiliate 8 Middle Initial - Affiliate 8 Last Name - Affiliate 8 Job Title - Affiliate 8 Email Address - Affiliate 8 Telephone - Affiliate 8 Cell Phone - Affiliate 8 Member Bio - Affiliate 8 Affiliate Member 9Salutation - Affiliate 9MrMrsMsDrFirst Name - Affiliate 9 Middle Initial - Affiliate 9 Last Name - Affiliate 9 Job Title - Affiliate 9 Email Address - Affiliate 9 Telephone - Affiliate 9 Cell Phone - Affiliate 9 Member Bio - Affiliate 9 Affiliate Member 10Salutation - Affiliate 10MrMrsMsDrFirst Name - Affiliate 10 Middle Initial - Affiliate 10 Last Name - Affiliate 10 Job Title - Affiliate 10 Email Address - Affiliate 10 Telephone - Affiliate 10 Cell Phone - Affiliate 10 Member Bio - Affiliate 10 Affiliate Member 11Salutation - Affiliate 11MrMrsMsDrFirst Name - Affiliate 11 Middle Initial - Affiliate 11 Last Name - Affiliate 11 Job Title - Affiliate 11 Email Address - Affiliate 11 Telephone - Affiliate 11 Cell Phone - Affiliate 11 Member Bio - Affiliate 11 Affiliate Member 12Salutation - Affiliate 12MrMrsMsDrFirst Name - Affiliate 12 Middle Initial - Affiliate 12 Last Name - Affiliate 12 Job Title - Affiliate 12 Email Address - Affiliate 12 Telephone - Affiliate 12 Cell Phone - Affiliate 12 Member Bio - Affiliate 12 Affiliate Member 13Salutation - Affiliate 13MrMrsMsDrFirst Name - Affiliate 13 Middle Initial - Affiliate 13 Last Name - Affiliate 13 Job Title - Affiliate 13 Email Address - Affiliate 13 Telephone - Affiliate 13 Cell Phone - Affiliate 13 Member Bio - Affiliate 13 Affiliate Member 14Salutation - Affiliate 14MrMrsMsDrFirst Name - Affiliate 14 Middle Initial - Affiliate 14 Last Name - Affiliate 14 Job Title - Affiliate 14 Email Address - Affiliate 14 Telephone - Affiliate 14 Cell Phone - Affiliate 14 Member Bio - Affiliate 14 Payment InformationPayment Method* Credit Card - Online Payment eCheck (Bank Wire w/o processing fee) - Online Payment Check Invoice If paying by Check, make payable toAmerican Membrane Technology Association1811 Englewood Rd., #280Englewood, FL 34223 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.