SCMA Membership Renewal 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, $25Submit proof of student full time status*Please upload your supporting proof of enrollment document. 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*Not Applicable, InternationalALAKAZARCACOCTDEFLGAHIIDILINIAKSKYLAMEMDMAMIMNMSMOMTNENVNHNJNMNYNCNDOHOKORPARISCSDTNTXUTVTVAWAWVWIWYZIP/Postal Code*Country*USAAfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina 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 PhoneEmail Address*Primary'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 applicableBe advised, SCMA’s mailing address has changed: 2409 SE Dixie Hwy., Stuart, FL 34996Billing Contact NameBilling Contact EmailEmail address sent to billing contact, if applicable Billing Contact Phone Please send copy of the invoice/receipt to Billing Contact Additional MembersDivision IB - Additional Members Price: $50.00 How many Additional Members will you include in this application?Count - Additional Members (IB)0123456789101112131415Division IIB - Additional Members Price: $100.00 How many Additional members will you include in this application?Count - Additional Members (IIB)0123456789101112131415 Additional Member 11*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee1r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 1*Mr.Mrs.Ms.Dr.First Name - Additional Member 1*Middle Initial - Additional Member 1Last Name - Additional Member 1*Job Title - Additional Member 1*Email Address - Additional Member 1* Member Bio - Additional Member 1 Additional Member 22*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee2r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 2*Mr.Mrs.Ms.Dr.First Name - Additional Member 2*Middle Initial - Additional Member 2Last Name - Additional Member 2*Job Title - Additional Member 2*Email Address - Additional Member 2* Member Bio - Additional Member 2 Additional Member 33*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee3r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 3*Mr.Mrs.Ms.Dr.First Name - Additional Member 3*Middle Initial - Additional Member 3Last Name -Additional Member 3*Job Title - Additional Member 3*Email Address - Additional Member 3* Member Bio - Additional Member 3 Additional Member 44*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee4r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 4*Mr.Mrs.Ms.Dr.First Name - Additional Member 4*Middle Initial - Additional Member 4Last Name - Additional Member 4*Job Title - Additional Member 4*Email Address - Additional Member 4* Member Bio - Additional Member 4 Additional Member 55*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee5r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 5*Mr.Mrs.Ms.Dr.First Name - Additional Member 5*Middle Initial - Additional Member 5Last Name - Additional Member 5*Job Title - Additional Member 5*Email Address - Additional Member 5* Member Bio - Additional Member 5 Additional Member 66*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee6r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 6*Mr.Mrs.Ms.Dr.First Name - Additional Member 6*Middle Initial - Additional Member 6Last Name - Additional Member 6*Job Title - Additional Member 6*Email Address - Additional Member 6* Member Bio - Additional Member 6 Additional Member 77*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee7r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 7*Mr.Mrs.Ms.Dr.First Name - Additional Member 7*Middle Initial - Additional Member 7Last Name - Additional Member 7*Job Title - Additional Member 7*Email Address - Additional Member 7* Member Bio - Additional Member 7 Additional Member 88*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee8r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 8*Mr.Mrs.Ms.Dr.First Name - Additional Member 8*Middle Initial - Additional Member 8Last Name - Additional Member 8*Job Title - Additional Member 8*Email Address - Additional Member 8* Member Bio - Additional Member 8 Additional Member 99*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee9r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 9*Mr.Mrs.Ms.Dr.First Name - Additional Member 9*Middle Initial - Additional Member 9Last Name - Additional Member 9*Job Title - Additional Member 9*Email Address - Additional Member 9* Member Bio - Additional Member 9 Additional Member 1010*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee10r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 10*Mr.Mrs.Ms.Dr.First Name - Additional Member 10*Middle Initial - Additional Member 10Last Name - Additional Member 10*Job Title - Additional Member 10*Email Address - Additional Member 10* Member Bio - Additional Member 10 Additional Member 1111*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee11r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 11*Mr.Mrs.Ms.Dr.First Name - Additional Member 11*Middle Initial - Additional Member 11Last Name - Additional Member 11*Job Title - Additional Member 11*Email Address - Additional Member 11* Member Bio - Additional Member 11 Additional Member 1212*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee12r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 12*Mr.Mrs.Ms.Dr.First Name - Additional Member 12*Middle Initial - Additional Member 12Last Name - Additional Member 12*Job Title - Additional Member 12*Email Address - Additional Member 12* Member Bio - Additional Member 12 Additional Member 1313*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee13r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 13*Mr.Mrs.Ms.Dr.First Name - Additional Member 13*Middle Initial - Additional Member 13Last Name - Additional Member 13*Job Title - Additional Member 13*Email Address - Additional Member 13* Member Bio - Additional Member 13 Additional Member 1414*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee14r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 14*Mr.Mrs.Ms.Dr.First Name - Additional Member 14*Middle Initial - Additional Member 14Last Name - Additional Member 14*Job Title - Additional Member 14*Email Address - Additional Member 14* Member Bio - Additional Member 14 Additional Member 1515*Yes, renew this individual's membershipDo not renew this individual, no longer an employeeDo not renew this individual, still an employee15r*Replace individual with this employeeDo not renew, do not replace Division IB - Additional Member - Do Not Renew Price: -$50.00 Division IIB - Additional Member - Do Not Renew Price: -$100.00 Please replace the current individual's information with the new person's informationSalutation - Additional Member 15*Mr.Mrs.Ms.Dr.First Name - Additional Member 15*Middle Initial - Additional Member 15*Last Name - Additional Member 15*Job Title - Additional Member 15*Email Address - Additional Member 15* Member Bio - Additional Member 15 Total $0.00 Payment InformationPayment Method*Credit Card - Online PaymenteCheck (Bank Wire w/o processing fee) - Online PaymentCheckInvoiceIf paying by check, make payable to South Central Membrane AssociationMail to: 2409 SE Dixie Hwy., Stuart, FL, 34996. 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