FORUM

MEMBERSHIP APPLICATION FORM / Date:
MEMBERSHIP DUES:
Membership: $15,000USD/year. Payable by check, wire transfer or credit card* (Visa, MC or AMEX). Details below.
Note: One membership per company. Membership term is one year. Membership renewals will be automatically billed two months prior to your anniversary month.
COMPANY INFORMATION:
Company:
Address:
City: / State/Region: /
Post Code/Zip: /
Country:
Phone: / Fax:
Web Site URL: /
Company Email:*
(*Note: Generic corporate email address only, for questions and information. Format example: or similar)
INDUSTRY CLASSIFICATION /
Service Provider: / ☐ /
Equipment Manufacturer: / ☐ /
Test Equipment: / ☐ /
Test Lab: / ☐ /
Other: / ☐ /
PRIMARY REASON FOR JOINING MEF /
Certification: / ☐ /
Market Profile & Networking: / ☐ /
Industry Influence: / ☐ /
Advance Intel on Market Trends: / ☐ /
Other: / ☐ /
BILLING CONTACT:
Name: / Email: / Phone:
PRIMARY CONTACT:(Supply information for the main company contact for the MEF Forum.)
Name: / Title:
Phone: / Email:
ADDITIONAL COMPANY CONTACTS:(Preferred, but not required. One name per category; names may repeat.)
Marketing Contact: / Title: / Email:
Technical Contact: / Title: / Email:
Primary Technical Committee Voter: / Email:
Marketing Committee Voter: / Email:
Services Operation Committee Voter: / Email:
CertificationCommittee Voter: / Email:
ACCEPTANCE:
We agree to abide by the bylaws of and request membership in the MEF Forum. We recognize it is the member company's responsibility to ensure its representative and contact information is current and correct. We agree to allow the MEF Forum web site to publish the COMPANY INFORMATION above and to link from the MEF Forum site to the URL provided above.
Authorized Signature, Title
TO COMPLETE YOUR MEMBERSHIP APPLICATION:
1. Please ensure the email addresses listed above are accurate. All MEF Forum communications will be conducted via email.
2. To initiate the membership process, please send the completed membership application along with payment to:
MEF FORUM, 6033 W. Century Boulevard, Suite 1107, Los Angeles, CA 90045 USA
Tel: +1 310-642-2800 • Fax: +1 310-642-2808 • Email:
* Please make checks payable to: MEF Forum (MEF)
* A fee applies to credit card charges. There will be a $500.00 USD additional fee for membership dues paid by credit card.
* A credit card authorization form and wire transfer details follow.

Form Date: 1/22/2016

FORUM
Credit Card Authorization Form

Date:

Requester:

Company:

Charge Amount:

(An additional fee of $500 will be charged for credit card payments)

Credit Card

AMEX_____VISA_____Discover_____MasterCard_____

Card Number______EXP:______CV Code:______

Address______City______
ST_____ Zip______

Name as shown on card______

Please sign authorization to use the card for the amount shown above:

Print Name of Authorizer______

Signature of Authorizer______

Please email the form to or fax to 310-642-2808.

MEF Forum

6033 W. Century Boulevard, Suite 1107

Los Angeles, CA 90045

Phone: +1 310 642 2800, Fax: +1 310 642 2808

FORUM

Wire Transfer Info:

Beneficiary:
MEF Forum (MEF)

Beneficiary Address:
6033 West Century Blvd.

Suite 1107

Los Angeles, CA 90045 USA

Beneficiary Bank:
Comerica Bank

Bank Address:

Comerica Bank

333 West Santa Clara Street

San Jose, CA 95113 USA

Bank Account #:

1891440750

Swift Address (for Int’l):
MNBDUS33

Routing Number/ABA#:
121137522