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/Province*ZIP/Postal Code*Country* 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)0123456789101112131415Total $0.00 Additional Member 11Do not renew this individual, no longer an employeeDo not renew this individual, still an employee1rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 22Do not renew this individual, no longer an employeeDo not renew this individual, still an employee2rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 33Do not renew this individual, no longer an employeeDo not renew this individual, still an employee3rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 44Do not renew this individual, no longer an employeeDo not renew this individual, still an employee4rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 55Do not renew this individual, no longer an employeeDo not renew this individual, still an employee5rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 5 Additional Member 66Do not renew this individual, no longer an employeeDo not renew this individual, still an employee6rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 6 Additional Member 77Do not renew this individual, no longer an employeeDo not renew this individual, still an employee7rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 7 Additional Member 88Do not renew this individual, no longer an employeeDo not renew this individual, still an employee8rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 8 Additional Member 99Do not renew this individual, no longer an employeeDo not renew this individual, still an employee9rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 9 Additional Member 1010Do not renew this individual, no longer an employeeDo not renew this individual, still an employee10rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 10 Additional Member 1111Do not renew this individual, no longer an employeeDo not renew this individual, still an employee11rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 11 Additional Member 1212Do not renew this individual, no longer an employeeDo not renew this individual, still an employee12rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 12 Additional Member 1313Do not renew this individual, no longer an employeeDo not renew this individual, still an employee13rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 13 Additional Member 1414Do not renew this individual, no longer an employeeDo not renew this individual, still an employee14rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 14 Additional Member 1515Do not renew this individual, no longer an employeeDo not renew this individual, still an employee15rReplace individual with this employeeDo not renew, do not replacePlease replace the current individual's information with the new person's information Salutation - 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 AssociationMail to: 2409 SE Dixie Hwy., Stuart, FL, 34996. 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