USEA Membership Application

Please fill out the information accurately as it will be used in our databases.

Name *

Web Address

MEMBER REPRESENTATIVE (VOTING MEMBER & INVOICE RECEIPIENT)

Representative Name *

Title

Address

Phone *

Fax

E-mail *

Membership Dues Structure

Please check the appropriate category listed below. Annual membership invoices are distributed in January each year. Cancellation of membership must be in writing and signed by the voting member. Members canceling in mid-year are expected to pay prorated dues for that year.
1. Energy Companies, Trade Associations, Manufacturers & Engineering Companies (Membership dues for this category are based on the annual revenue of the organization according to the chart located to the right)	Prior Year’s Revenue (Millions) $100+ $50+ $10+ $5+ Under $5	Dues $5,000 $4,000 $3,500 $2,500 $2,000
2. Professional Societies, Federal Government Agencies, Professional Service Firms, Universities, Educational Organizations & State Government Agencies	$1,000

Referral

Who referred you to USEA membership?

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