2012 Calendar Year Membership Application
Company Name: _______________________________________________________________________
Address / Site / Facility:__________________________________________________________________
City, State, Zip: ________________________________________________________________________
Company Telephone: _____________________________ Fax:_________________________________
Primary Contact***:____________________________________________________________________
Direct Telephone: ______________________________________________________________________
Primary E-mail Address: _________________________________________________________________
Corporate Website Address: ______________________________________________________________
Additional 3 Company - Division Contacts:
Contact: _______________________________________ E-mail: ________________________________
Contact: _______________________________________ E-mail: ________________________________
Contact: _______________________________________ E-mail: ________________________________
Membership Dues:$1,200.00 Per Year, Per Company Division, Subsidiary.
Multiple subsidiaries are requested to complete a membership form and pay dues per division, subsidiary and /or location. (Dues are not prorated, all memberships renew the first of January).
***Please Sign:
Applicant Company Authorized Signature and Tile: (Opt-In Company Member Directory Page)
_____________________________ _____________________________
Mail membership form and payment to:
P.O. Box 14329 * Arlington * Texas * 76094 – 1329
NASML Tax ID Number: 20-2691786
(W-9 Tax ID Form upon request)