Membership Application "*" indicates required fields This will serve as a letter of intent of the organization listed below 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. All items marked with asterisk (*) are required.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 FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Please provide logoPlease attach logo (Max file size 512MB - .jpg .gif .png .pdf)Accepted file types: jpg, gif, png, pdf, Max. file size: 512 MB.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 Member qualifications and benefits vary by membership level as described at Membership Information : Membership Levels. Membership dues are based on member’s annual revenue. Annual Revenue* Select Desired Membership Level and Dues Tier Based on Annual RevenueSelect only oneLeadership (revenue = dues) <$100 Million = $14,000 $100 Million-$1 Billion = $18,000 >$1 Billion = $20,000 Global Payment Networks = $30,000 Principal (revenue = dues) Start-up (<2 yrs.) = $4,000 Merchants = $14,000 <$5 Million = $6,000 $5-$10 Million = $8,000 $10-$50 Million = $10,000 $50-$100 Million = $12,000 $100-$500 Million = $14,000 >$500 Million = $16,000 General (revenue = dues) Start-up (<2 yrs.) = $1,200 Merchants = $6,000 <$5 Million = $3,000 $5-$10 Million = $4,000 $10-$50 Million = $5,000 $50-$100 Million = $6,000 $100-$500 Million = $7,000 >$500 Million = $8,000 Associate All government agencies, colleges & universities, and industry associations = $2100 Individual Student = $50 Retiree = $600 Individual = $1,200 Acknowledgment* The prospective member intends to join the Secure Technology Alliance at the membership level indicated above and agrees to pat the annual dues. Payment terms are 30 days from the date of submitting this application. The Secure Technology Alliance membership year runs for one year starting with the first day of the month joined and renews automatically on the anniversary date unless prior notice of cancellation is provided in writing. The Secure Technology Alliance does not lobby, and no allocation of dues is necessary for tax purposes.*Bylaws Agreement* I acknowledge that I have read the Secure Technology Alliance bylaws at Membership Information : Bylaws and Policies, agree to comply with the bylaws and policies established by the Board, pay the annual dues until notifying the Alliace of non-renewal in writing, meet the qualifications for the membership level selected, and agree to the Terms and Conditions of the Secure Technology Alliance.*Details of your Industry, Products Offered, and Markets ServedIndustry Classification*(Select all that apply) Acquirer Bank Consultant Cryptocurrency Distributor End User Gateway Global Payment Network Government (Federal, State, Local) Industry Association Industry Supplier Integrator ISO Issuer ISV Merchant Mobile Payments Other Fintech Processor Domestic Debit Network Service Provider Software Products Student Retiree Systems Manufacturer (HW &/or SW) University (or College) ATM Network Other Other Products Offered*(Select all that apply) ATM Biometrics Card Issuance Cards Credential Issuance Encryption Integration Services IoT NFC (cards or devices) Payments Payments Applications Readers Secure Chip Services Smart Cards Software Terminals Other Devices Other Other Other Devices Markets Served*(Select all that apply) Corporate Education Financial Government Healthcare Identity/Access Insurance IoT Manufacturing Merchants/Retail Transportation Utilities Other Other Government Agencies Served Payment DetailsUpon approval of the application, the Alliance will send the new member an electronic invoice. Payment may be made by credit card, wire transfer, or check. Instructions for each payment method will be included with the electronic invoice.Member Primary Point of ContactName* First Last Title* Email address* Work Phone*Mobile PhoneFaxAlternate Point of ContactName* First Last Title* Email address* Work Phone*Mobile PhoneFaxPlease list the referring Secure Technology Alliance member that led you to join, if applicableName First Last Company If you have any questions or issues while filling out the form, please email Deb Ferril: [email protected] or download the application and email to Deb Ferril.CommentsThis field is for validation purposes and should be left unchanged. Related: Application TWIC Security Certified Identification Professional Application Application 2011 e-Yearbook
