SCMA Membership Renewal MemberPlease refrain from using all caps/uppercase letters, please use sentence structure letter case.Salutation*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 applicant's email address Website Volunteer OpportunitiesPlease indicate which committees you would be interested in serving on: Please note, an official Willingness to Serve form is required to be submitted for Board Approval (download Willingness to Serve Form, link above)Committee Preferences Audit Awards / Scholarships Conference Planning Committee (CPC) Legislative / Regulatory Membership Nomination / Election Publications / Newsletter Training / Certification (T/C also called MOC) Other Interests I am interested in running for a position on the SCMA Board of Directors. I am interested in presenting at a SCMA Conference, Workshop, or MOC School. Company Description & Member BioCompany DescriptionMember Bio Billing Contact InformationEnter billing contact information, if applicableBilling Contact Name First Last Billing Contact EmailEmail address sent to billing contact, if applicable Billing Contact Phone Please send copy of the invoice/receipt to Billing Contact Membership LevelPublic and Private Agencies, Industrial Users, and Water Suppliers(includes 1 (1A) primary member and $50 per additional members (1B) from the same organization) Manufacturers, Suppliers, Consulting Firms:(includes 1 (2A) primary member and $100 per additional members (2B) from the same organization) Membership Type*Division IA - Public and Private Agencies, Industrial Users, and Water Suppliers, $200Division IB - Additional of a Division I Member, $50Division IIA - Manufacturers, Suppliers, Consulting Firm, $350Division IIB - Additional of a Division II Member, $100Division III - Individuals, Libraries, Well-wishers, $100Division IV - Full-time College or High School Students, $25Division IB - Additional Members Price: $50.00 How many Additional Members will you include in this application?Count0123456789101112131415Division IIB - Additional Members Price: $100.00 How many Additional members will you include in this application?Count0123456789101112131415Total $0.00 Additional Member 1Salutation - Additional Member 1Mr.Mrs.Ms.Dr.First Name - Additional Member 1Middle Initial - Additional Member 1Last Name - Additional Member 1Job Title - Additional Member 1Email Address - Additional Member 1 Member Bio - Additional Member 1 Additional Member 2Salutation - Additional Member 2Mr.Mrs.Ms.Dr.First Name - Additional Member 2Middle Initial - Additional Member 2Last Name - Additional Member 2Job Title - Additional Member 2Email Address - Additional Member 2 Member Bio - Additional Member 2 Additional Member 3Salutation - Additional Member 3Mr.Mrs.Ms.Dr.First Name - Additional Member 3Middle Initial - Additional Member 3Last Name -Additional Member 3Job Title - Additional Member 3Email Address - Additional Member 3 Member Bio - Additional Member 3 Additional Member 4Salutation - Additional Member 4Mr.Mrs.Ms.Dr.First Name - Additional Member 4Middle Initial - Additional Member 4Last Name - Additional Member 4Job Title - Additional Member 4Email Address - Additional Member 4 Member Bio - Additional Member 4 Additional Member 5Salutation - Additional Member 5Mr.Mrs.Ms.Dr.First Name - Additional Member 5Middle Initial - Additional Member 5Last Name - Additional Member 5Job Title - Additional Member 5Email Address - Additional Member 5 Member Bio - Additional Member 5Additional Member 6Salutation - Additional Member 6Mr.Mrs.Ms.Dr.First Name - Additional Member 6Middle Initial - Additional Member 6Last Name - Additional Member 6Job Title - Additional Member 6Email Address - Additional Member 6 Member Bio - Additional Member 6Additional Member 7Salutation - Additional Member 7Mr.Mrs.Ms.Dr.First Name - Additional Member 7Middle Initial - Additional Member 7Last Name - Additional Member 7Job Title - Additional Member 7Email Address - Additional Member 7 Member Bio - Additional Member 7Additional Member 8Salutation - Additional Member 8Mr.Mrs.Ms.Dr.First Name - Additional Member 8Middle Initial - Additional Member 8Last Name - Additional Member 8Job Title - Additional Member 8Email Address - Additional Member 8 Member Bio - Additional Member 8Additional Member 9Salutation - Additional Member 9Mr.Mrs.Ms.Dr.First Name - Additional Member 9Middle Initial - Additional Member 9Last Name - Additional Member 9Job Title - Additional Member 9Email Address - Additional Member 9 Member Bio - Additional Member 9Additional Member 10Salutation - Additional Member 10Mr.Mrs.Ms.Dr.First Name - Additional Member 10Middle Initial - Additional Member 10Last Name - Additional Member 10Job Title - Additional Member 10Email Address - Additional Member 10 Member Bio - Additional Member 10Additional Member 11Salutation - Additional Member 11Mr.Mrs.Ms.Dr.First Name - Additional Member 11Middle Initial - Additional Member 11Last Name - Additional Member 11Job Title - Additional Member 11Email Address - Additional Member 11 Member Bio - Additional Member 11Additional Member 12Salutation - Additional Member 12Mr.Mrs.Ms.Dr.First Name - Additional Member 12Middle Initial - Additional Member 12Last Name - Additional Member 12Job Title - Additional Member 12Email Address - Additional Member 12 Member Bio - Additional Member 12Additional Member 13Salutation - Additional Member 13Mr.Mrs.Ms.Dr.First Name - Additional Member 13Middle Initial - Additional Member 13Last Name - Additional Member 13Job Title - Additional Member 13Email Address - Additional Member 13 Member Bio - Additional Member 13Additional Member 14Salutation - Additional Member 14Mr.Mrs.Ms.Dr.First Name - Additional Member 14Middle Initial - Additional Member 14Last Name - Additional Member 14Job Title - Additional Member 14Email Address - Additional Member 14 Member Bio - Additional Member 14Additional Member 15Salutation - Additional Member 15Mr.Mrs.Ms.Dr.First Name - Additional Member 15Middle Initial - Additional Member 15Last Name - Additional Member 15Job Title - Additional Member 15Email Address - Additional Member 15 Member Bio - Additional Member 15 Payment InformationPayment Method*Credit Card - Online PaymenteCheck (Bank Wire w/o processing fee) - Online PaymentCheckInvoiceIf paying by Check, make payable to South Central Membrane Association, and mail to 14900 Avery Ranch Blvd., Suite C200 #300, Austin, TX 78717 CommentsQuestions/CommentsCaptchaPlease refer to SCMA’s Privacy Policy if you have any questions regarding your preferences.