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Membership Application


General Information

Name of Company:
Number of years in Business:
Type of Operation: Individual Partnership
Public or Privately Held Corporation Public Private
Please check the appropriate boxes: Woman Minority

Primary Contact for this membership application (If other than signatory)


Name:
Title:
Mailing Address:
City:
State:
Zip/Postal Code:
Telephone Number:   
Fax Number:   
Email:

Additional Information


What is your company’s primary business?
Does your company engage in the manufacture or distribution of alcohol, tobacco, firearms or other controlled substances? Yes No
What products and/or services do you plan to market to higher education and affiliated communities?
Do you currently have any special programs geared to higher education? Please Identify briefly below:
Do you have any special programs geared to the K-12 market?
Does your company currently have a contract relationship with E&I? Yes No
Does your company currently have a contract relationship with any other consortia? If so, please indicate which: Yes No
Indicate below how your company can contribute to and further the work of the Association:

Business Membership Opportunities:


Basic Membership Package
Basic Membership Dues:
1-2 representatives $ 995
3-4 representatives $ 1,095
5+ representatives $ 1,295

Enhanced Business Affiliate Packages

*Platinum Affiliate Package ($30,000)
*Gold Affiliate Package ($15,000)
*Silver Affiliate Package ($5,000)
*The Enhanced Business Affiliate Packages also include your membership dues.
For details on the Enhanced Business Affiliate Packages refer to the brochure.

Name:
Title:
Date:
*By signing above, you are also certifying that the above named company is not currently on the Excluded Parties List System (EPLS) of the Federal Government. By signing above you are also certifying that the above named company is not currently on any State debarred or suspended list of vendors. The Association reserves the right to approve or deny applications for Business Affiliate memberships in order to best serve the interests and mission of the Association. NAEP reserves the right to deny membership to any company involved in the manufacture or distribution of alcohol, tobacco, firearms or other controlled substances. Membership in the Business Affiliate Program is not to be construed as an endorsement, actual or implied, by the Association of any product or service.
 
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