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 $18,000Leadership Council Member - US $14,000General Member - US $6,000Government Member - US $2,100University Member - US $2,100Associate Member - US $1,400Associate Member - US $1,200 (US $960 for Secure Technology Alliance members)* 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.Method of PaymentMethod of Payment*CheckCredit Card* (Accept Visa, Mastercard, American Express, Discover, JCB)Wire Transfer*Make checks payable to “The Secure Technology Alliance,” and mail to: Secure Technology Alliance, 191 Clarksville Road, Princeton Junction, NJ 08550. *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 CountryAfghanistanÅland IslandsAlbaniaAlgeriaAmerican 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 RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican 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 RicoQatarRéunionRomaniaRussiaRwandaSaint 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 IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe Country Please provide logoIf available (allowed file types: jpg, gif, png, pdf).Accepted file types: jpg, gif, png, pdf.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 CardsSecure ChipEncryptionSoftwareReadersBiometricsIntegration ServicesPaymentsOtherOther Description*Provide short description of company*Permission to include company name on membership lists for general marketing purposes*YesNoPermission to provide link from Secure Technology Alliance site to your organization's website*YesNoIf 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 CompanyAdditional 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 Randy Vanderhoof: [email protected].CAPTCHACommentsThis field is for validation purposes and should be left unchanged. Related: Membership Application U.S. Payments Forum Membership Information 2011 e-Yearbook
