APPLICATION FOR IRI MEMBERSHIP

(For confidential use by Board of Directors and Membership Committee)


Complete the form below and hit submit. If you have any questions, contact Gary Schiffres (703) 647-2586, schiffres@iriweb.org or gschiffres@nam.org.

Is your organization a government or federal lab? No Yes

Company Name:
Principal products and / or services:
Industrial classification of company businesses (express as percent of total)
Aerospace Industrial Machinery & Equipment
Chemicals & Advanced Materials Industrial Products not listed elsewhere
Communications, Telecom Networks, &/or Systems Paper & Allied Products
Computer & Computer Related Products Personal Care
Consumer Products not listed elsewhere Petroleum & Related Products
Electronics Primary Metal Industries
Fabricated Metal Products Professional & Scientific Instruments
Food, Tobacco, & Related Products R&D Services
Genetic Engineering/Molecular Biology Textile Products & Apparel
Healthcare, including Medical Products & Pharmaceuticals Transportation & Public Utilities
Other
We will designate the following persons to represent the company in IRI:
VOTING REPRESENTATIVE (VR) ALTERNATE REPRESENTATIVE (R)
Name: * Name: *
Title: * Title: *
Company: * Company: *
Address: * Address: *
Address2: Address2:
City: * City: *
State: * State: *
Zip: * Zip: *
Phone: * Phone: *
Fax: Fax:
Email: * Email: *
Website: Website:
(Optional) If the VR is not the CTO or equivalent of your company please fill in the following information about the CTO of your company:
Name:
Title:
Phone:
Fax:
Email:

In order to complete the application, please check the boxes below.

 

* I give IRI permission to store the information provided as it is necessary in order to process this membership application form. IRI will not share any personal information without your consent. I understand I can request to have my information removed at any time.

Our designated Voting Representative is qualified to represent our research, development and/or engineering functions, authorized to participate in all activities of the Institute, and to vote on our behalf.
  * We certify that our company is a firm, institution, or other organization offering primarily commercial products or services. Our business purpose is the creation, production, and commercial offering of physical or intellectual products or services based on technological innovation including research, development, design, introduction, and technical support of products or services. We certify that our company has 20+ degreed, technical personnel and performs $5+ million US dollars in Research & Development.
Submitted By:
Email: *
Title: