GWEC MEMBERSHIP APPLICATION:
INDUSTRY
* = required information
ABOUT YOUR ORGANIZATION

*NAME OF YOUR ORGANIZATION

WEBSITE URL FOR YOUR ORGANIZATION
Please enter a brief DESCRIPTION of your
company below (for the GWEC website)
ABOUT THE PERSON WHO WILL
REPRESENT YOUR COMPANY

*LAST NAME

*FIRST NAME

* (select one)

DEPARTMENT
*TITLE

*ADDRESS Line 1

ADDRESS Line 2

*COUNTRY

*CITY       *STATE/PROV if US or Canada

STATE

*POSTAL CODE

*PHONE

FAX

*EMAIL
*TYPE OF MEMBERSHIP
Company
Gross
Revenues		 Annual
GWEC Membership
Fee
Class One Over $3B $30,000
Class Two
Between $1B and $3B
$20,000
Class Three Between $200M and $1B
$10,000
Class Four Under $200M
$ 5,000
IF OTHER THAN CONTACT PERSON NAMED ABOVE,
TO WHOM SHOULD THE FEES INVOICE BE SENT?

LAST NAME

FIRST NAME

(select one)

DEPARTMENT

TITLE

ADDRESS Line 1

ADDRESS Line 2

COUNTRY

CITY

STATE

POSTAL CODE

PHONE

FAX

EMAIL
* CONTACT FOR PRESS RELEASES/MEDIA INTERVIEWS
(Required) Please complete the information below for the person from your company that will be the main GWEC contact for press releases and interviews. If the name is the same as in the section(s) above, name (first and last) only is sufficient.

LAST NAME

FIRST NAME

(select one)

DEPARTMENT

TITLE

ADDRESS Line 1

ADDRESS Line 2

COUNTRY

CITY

STATE

POSTAL CODE

PHONE

FAX

EMAIL
* GWEC CURRICULUM COMMITTEE
(Required) Please complete the information below for the person from your company that will be the main GWEC for curriculum (notices, reviews, questions, etc.). If the name is the same as in the section(s) above, name (first and last) only is sufficient.

LAST NAME

FIRST NAME

(select one)

DEPARTMENT

TITLE

ADDRESS Line 1

ADDRESS Line 2

COUNTRY

CITY

STATE

POSTAL CODE

PHONE
FAX

EMAIL
* GWEC PRACTICAL WORK EXPERIENCE COMMITTEE
(Required) Please complete the information below for the person from your company that will be the main GWEC liaison for internships (notices, questions , etc.). If the name is the same as in the section(s) above, name (first and last) only is sufficient.

LAST NAME

FIRST NAME

(select one)

DEPARTMENT

TITLE

ADDRESS Line 1

ADDRESS Line 2

COUNTRY

CITY

STATE
POSTAL CODE

PHONE

FAX

EMAIL





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