Corporate Membership Application

Company InformationCompany Web Address

Business Address

City State/Province Zip/Postal Code Country

Business Phone Business Fax

Primary Contact Name Primary Contact E-mail

Airports

Gas and Liquid Pipelines

Hazardous Material Storage

Highways/Bridges

Railroads

Waterways and Ports

Other Infrastructure

B. My company serves these industry segments (select all that apply) INFRASTRUCTURE

Coal

Electric

Gas Distribution

Nuclear

Solar

Telecommunications

Water/Wastewater

Wind

UTILITIESAerospace/Aircraft

Automotive/Motor Vehicle

Hazardous Material Transport

Marine/Ships

Railroad Cars

Other Transportation

TRANSPORTATIONAgricultural Equipment

Chemical - Petrochemical

Electronics

Food Processing

Home Appliances

Medical

Mining

Oil and Gas Exploration & Production

Pulp & Paper

PRODUCTION & MANUFACTURINGDOD – Military

Nuclear Waste Storage

Other/Industry Segment Not Listed

GOVERNMENT

C. Company function (select all that apply) Above Ground Storage

Architectural/Design

Cathodic/Anodic Protection

Chemical Processing

Coatings

Concrete

Construction

Contractor, Commercial Coatings

Contractor, Concrete Specialty and/or Parking Structure

Contractor, Flooring

Contractor, General

Contractor, Industrial Plant or Military Facilities Maintenance

Contractor, Insulation

Contractor, Sandblast/Waterblast/Surface Prep

Contractor, Spray Bed Liner

Contractor, Structural Steel, Metal Tank and/or Pipeline

Engineering

Fleet Operator

Inspection Services

Insulation

Insurance

Legal Services

Linings

Maintenance/Rehabilitation

Materials Selection & Design

Measuring, Analyzing & Controlling Instrumentation

Metal Fabrication

Onshore

Original Equipment Manufacturer

Power/Energy Distribution

Power/Energy Generation

Power/Energy Transmission

Rail Cars/Tank Trucks

Laboratory/Research

Ship Building

Surface Preparation/Blasting

Testing Services

Training

Underground Storage

Water Domestic

Water Industrial

Wastewater Domestic

Wastewater Industrial

Wind

Other/Company Function Not Listed

D. Products my company produces or uses (select all that apply) Abrasives

Adhesives

Application Equipment

Cathodic/Anodic Protection

Chemical Inhibitors

Coatings

Concrete

Data Recording and Management Equipment/Software

Inspection Equipment

Insulation

Linings

Materials – Ferrous

Materials – Non-Ferrous

Mechanical Equipment/Machinery

Monitoring Equipment

Safety Equipment

Surface Preparation Equipment

Testing Equipment

Academia/ R&D

Asset Owner/Operator

A. My company is a(n) Association

Government/Regulatory Agency

Manufacturer/Supplier

Media/PR/Advertising Agency

Service Provider/Contractor

Information about your company’s technical and professional interests is maintained in the NACE database to serve you better. Please tell us about your company by completing the appropriate information in Sections A through D.

Materials – Non- Ferrous

Mechanical Equipment/Machinery

Monitoring Equipment

Safety Equipment

Surface Preparation Equipment

Testing Equipment

Surface Preparation Equipment Surface Preparation Equipment

Fax completed application & payment to: +1 281-228-6382

Mail completed application & payment to: NACE International15835 Park Ten PlaceHouston, TX 77084-4906 USA

3 Ways to Join

3.

2.

1.

Questions?

Options of Membership and Service

$2,000

$4,000

$8,000

$14,000

Amount Total1-year 2-years

Iron Member—includes 2 member representatives

Silver Member—includes 7 member representatives

Gold Member—includes 13 member representatives

Diamond Member—includes 20 member representatives

Corporate Plaque—New corporate companies will be sent a plaque automatically. Additional plaques may be ordered.

NACE Foundation Donation $100 $500 $1,000 Other

NACE Foundation of Canada Donation $100 $500 $1,000 Other

Donation in honor/memory of: __________________________________________________

• Corporate Discount on NACE Books• Unlimited $75 USD Discounts on NACE Courses•

Contact the Corporate Membership Coordinator directly at: +1 281-228-6282 or corporate@nace.org

Join online at: www.nace.org/corporate-membership

Corporate Membership Packages

*

visit www.nace.org/corporate-membership.

$1,000

$2,000

$4,000

$7,000

Corporat (Optional)

Payment

Add dues and options to calculate total amount to be paid. Amount paid

For faster processing, consider paying by credit card and faxing this form to NACE at +1 281-228-6382.Payments can be made by check, money order, or credit card in U.S. funds made payable to NACE.

Please invoice Check/money enclosed: U.S. $__________ Check number: __________

Credit card payment MasterCard VISA American Express Discover

Account number:__________________________________ Expiration date: ____/____

Name as it appears on card: ________________________________________________

Signature:___________________________________________________________

NACE Foundation donations sustain the independent NACE Foundation. The NACE Foundation works with schools and universities to advance corrosion education and support such activities as education outreach programs and scholarships for deserving students. U.S. donations are tax-deductible to the full extent of the law. Contributions may not be tax-deductible outside of the U.S.; therefore, review your local tax laws. For information, contact the NACE Foundation at +1 281-228-6205 or visit www.nace-foundation.org.

$40

$100

$____

$____

-

-

Recertification Fee Waived ($240 USD value) ‡

‡ Certifications are administered through the NACE International Institute, the independent certification affiliate of NACE International.

Please complete the attached page(s) for each additional member representative to receive benefits.

Primary Member Representative—Personal DataName (First, Middle, Last) Birthdate (MM/DD/YY)

Preferred Mailing Address

City State/Province Zip/Postal Code Country

Home Phone Business Phone

E-mail

Architect/Designer

Attorney/General Council

Chemist

Coatings Applicator

Coatings Inspector

Consultant

F. My job function can be best described as (select all that apply)

I. Products I use or sell (select all that apply) Abrasives

Adhesives

Application Equipment

Cathodic/Anodic Protection

Chemical Inhibitors

Coatings

Concrete

Data Recording and Management Equipment/Software

Inspection Equipment

Insulation

Linings

Materials – Ferrous

Materials – Non-Ferrous

Mechanical Equipment/Machinery

Monitoring Equipment

Surface Preparation Equipment

Testing Equipment

Associate’s Degree Bachelor’s Degree

A. Gender

Master’s Degree Doctoral Degree Post-Doctoral Work Other Education Level

Professional Interests

/ /

Male Female

D. Education Level

C. Professional Engineer’s License Yes No

B. Preferred Language English Spanish Chinese

E. How did you first hear about NACE?

Contractor

Engineer

Executive/Senior Management

Health & Safety/Compliance Manager

Human Resources

Inspector

Integrity Manager

Maintenance

Project Manager/Supervisor

Media Buyer/Press Liaison/Account Executive

Plant/Facility Manager

Professor/Instructor

Purchasing/Buyer

QA/QC

Retired

Sales/Marketing

Scientist/Researcher

Specifier

Student

Systems Manager/Operator

Technician/Technologist

Tester

Trainer

Other/Job Function Not Listed

Recommend Specify Authorize BuyG. My role in product decisions (select all that apply)

Recommend Specify Authorize BuyH. My role in continuing education/professional development/training decisions (select all that apply)

Safety Equipment

Advertisement Education Course Internet NACE Catalog NACE Publication NACE Conference or Event Other

Surface Preparation Equipment

Member Representative—Personal DataName (First, Middle, Last) Birthdate (MM/DD/YY)

Preferred Mailing Address

City State/Province Zip/Postal Code Country

Home Phone Business Phone

E-mail

Architect/Designer

Attorney/General Council

Chemist

Coatings Applicator

Coatings Inspector

Consultant

F. My job function can be best described as (select all that apply)

I. Products I use or sell (select all that apply) Abrasives

Adhesives

Application Equipment

Cathodic/Anodic Protection

Chemical Inhibitors

Coatings

Concrete

Data Recording and Management Equipment/Software

Inspection Equipment

Insulation

Linings

Materials – Ferrous

Materials – Non-Ferrous

Mechanical Equipment/Machinery

Monitoring Equipment

Surface Preparation Equipment

Testing Equipment

Associate’s Degree Bachelor’s Degree

A. Gender

Master’s Degree Doctoral Degree Post-Doctoral Work Other Education Level

Professional Interests

/ /

Male Female

D. Education Level

C. Professional Engineer’s License Yes No

B. Preferred Language English Spanish Chinese

Advertisement Education Course Internet NACE Catalog NACE Publication NACE Conference or EventE. How did you first hear about NACE?

Other

Contractor

Engineer

Executive/Senior Management

Health & Safety/Compliance Manager

Human Resources

Inspector

Integrity Manager

Maintenance

Project Manager/Supervisor

Media Buyer/Press Liaison/Account Executive

Plant/Facility Manager

Professor/Instructor

Purchasing/Buyer

QA/QC

Retired

Sales/Marketing

Scientist/Researcher

Specifier

Student

Systems Manager/Operator

Technician/Technologist

Tester

Trainer

Other/Job Function Not Listed

Recommend Specify Authorize BuyG. My role in product decisions (select all that apply)

Recommend Specify Authorize BuyH. My role in continuing education/professional development/training decisions (select all that apply)

Safety Equipment

Please reprint this page for additional member representatives.