Membership Application

NAATBatt International

Need to renew your membership?

Select Your Mode of Payment: *

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Coupon

Legal Name of Applicant Company*

Applicable Class of Membership (select one):*

Platinum ($7500)

Gold ($5000)

Silver ($2500)

Special Silver ($1000)

Public Benefit Members ($1000)

By checking the following box, an applicant for Special Silver membership certifies that either (1) it is a subsidiary or affiliate of an existing NAATBatt Platinum Member, or (2) it has been engaged in business for less than three years, earned revenues of less than $500,000 in its last fiscal year, and is not a subsidiary or affiliate of any other business entity.

Name of Principal Contact at Applicant:*

Title of Principal Contact:*

Phone numbers and email address of principal contact:

Direct:*

Mobile:*

Email*

Mailing Address of Principal Contact:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Headquarter Address if different:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Employees (approximate):*

Brief description of applicant’s business (this may be used to announce applicant’s membership in the newsletter):*

Name of Ultimate Corporate Parent (if applicable):*

Applicant's Website (to which applicant's listing on NAATBatt's Website should link):*

Upload your company logo*

Max. file size: 50 MB.

Alternatively, you may email us high resolution (.jpeg preferred) copy of the applicant's logo to [email protected], which may be placed on the NAATBatt Web site.

Please tell us the principal objectives of your organization in joining NAATBatt (optional):

Total

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Phone

This field is for validation purposes and should be left unchanged.

Payment is due within three (3) Business Days following completion of the application. Please send e-mail confirmation of payment transmittal to: [email protected].

"*" indicates required fields

This field is hidden when viewing the form

Coupon

Legal Name of Applicant Company*

Applicable Class of Membership (select one):*

Platinum ($7500)

Gold ($5000)

Silver ($2500)

Special Silver ($1000)

Public Benefit Members ($1000)

Name of Principal Contact at Applicant:*

Title of Principal Contact:*

Phone numbers and email address of principal contact:

Direct:*

Mobile:*

Email*

Mailing Address of Principal Contact:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Headquarter Address if different:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Employees (approximate):*

Brief description of applicant’s business (this may be used to announce applicant’s membership in the newsletter):*

Name of Ultimate Corporate Parent (if applicable):*

Applicant's Website (to which applicant's listing on NAATBatt's Website should link):*

Upload your company logo*

Max. file size: 50 MB.

Alternatively, you may email us high resolution (.jpeg preferred) copy of the applicant's logo to [email protected], which may be placed on the NAATBatt Web site.

Please tell us the principal objectives of your organization in joining NAATBatt (optional):

Total

Chosen Mode of Payment: ACH or Wire Transfer (bank details after form submission)

Phone

This field is for validation purposes and should be left unchanged.

Payment is due within five (5) Business Days following completion of application. Please send confirmation of mailing your check by e-mail to: [email protected].

"*" indicates required fields

This field is hidden when viewing the form

Coupon

Legal Name of Applicant Company*

Applicable Class of Membership (select one):*

Platinum ($7500)

Gold ($5000)

Silver ($2500)

Special Silver ($1000)

Public Benefit Members ($1000)

Name of Principal Contact at Applicant:*

Title of Principal Contact:*

Phone numbers and email address of principal contact:

Direct:*

Mobile:*

Email*

Mailing Address of Principal Contact:*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Headquarter Address if different:

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Employees (approximate):*

Brief description of applicant’s business (this may be used to announce applicant’s membership in the newsletter):*

Name of Ultimate Corporate Parent (if applicable):*

Applicant's Website (to which applicant's listing on NAATBatt's Website should link):*

Upload your company logo*

Max. file size: 50 MB.

Alternatively, you may email us high resolution (.jpeg preferred) copy of the applicant's logo to [email protected], which may be placed on the NAATBatt Web site.

Please tell us the principal objectives of your organization in joining NAATBatt (optional):

Total

Chosen Mode of Payment: Mail a Check (full address details after form submission)

Phone

This field is for validation purposes and should be left unchanged.