Membership Application This will serve as a letter of intent of the organization listed above and hereinafter referred to as Prospective Member, to join the Secure Technology Alliance, a not-for-profit multi-industry member organization, with rights, privileges and responsibilities detailed in the bylaws of the Secure Technology Alliance.Select Membership LevelMembership Levels* Leadership Council PLUS Member* - US $18,000 Leadership Council Member - US $14,000 General Member - US $6,000 Government Member - US $2,100 University Member - US $2,100 Industry Association - US $1,750 Associate Member - US $1,400 * This PLUS membership level in the Secure Technology Alliance includes dual membership in the U.S. Payments Forum.The Secure Technology Alliance membership year runs for one year starting with the first month and day joined. The Secure Technology Alliance does not lobby and no allocation of dues is necessary for tax purposes. The prospective member intends to join the Secure Technology Alliance at the membership level indicated above and agrees to the annual dues. Payment terms are 30 days from the date of submitting this application.* I acknowledge that I have read the Secure Technology Alliance bylaws, meet the qualifications for the membership level selected, and agree to the terms and conditions of the Secure Technology Alliance.*Secure Technology Alliance membership runs for one year, beginning with the first day of the month that the application is received. This membership expires one year after the start date of this membership. The applying member intends to join the Secure Technology Alliance at the membership level indicated above and agrees to the payment of the annual membership fee. Payment terms are (30) days from the date of signing this application.Payment DetailsMethod of Payment* Check Credit Card* (Accept Visa, Mastercard, American Express, Discover, JCB) Wire Transfer* Make checks payable to “The Secure Technology Alliance,” and mail to: Secure Technology Alliance, 4680 S. Downing St. Englewood, CO 80113. *If paying by credit card or wire transfer, our membership administrator will email the Point of Contact with details on how to complete your payment.Organization DetailsOrganization Name* Website* Address* Street Address Address Line 2 City State / Province / Region ZIP / Postal Code CountryAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzech RepublicCôte d'IvoireDenmarkDjiboutiDominicaDominican 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 RicoQatarRomaniaRussiaRwandaRéunionSaint 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 IslandsTuvaluUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please provide logoIf available (allowed file types: jpg, gif, png, pdf).Accepted file types: jpg, gif, png, pdf, Max. file size: 512 MB.Primary Member Point of Contact(for official letters and renewal notices and/or payments)Name* First Last Title* Email* Phone*FaxPrimary Markets Served* Corporate Government Financial Healthcare Transportation IoT Identity/Access Other Other Description* Primary Service or Technology Offered* Smart Cards Secure Chip Encryption Software Readers Biometrics Integration Services Payments Other Other Description* Provide short description of company*Permission to include company name on membership lists for general marketing purposes* Yes No Permission to provide link from Secure Technology Alliance site to your organization's website* Yes No If yes, please provide exact URL to link to your website* Please list the referring Secure Technology Alliance member that led you to join, if applicableName First Last Company Additional Contact Names (other than the Primary Contact)Representing your company to receive communications like newsletters and invitations to Secure Technology Alliance programs, events, and other member activitiesListNameTitleEmail If you have any questions or issues while filling out the form please email Jason Bohrer: [email protected].CAPTCHANameThis field is for validation purposes and should be left unchanged. 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