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Associate Member Renewal

UTC Canada Membership Year- Jannuary 1, 2010 through December 31, 2010

Please fill out each field in its entirety, using the Tab key or your mouse to advance to the next field. Please do not use the Enter/Return key, as this may cause your form to be submitted before you have completed your work. If you are unable to pay by credit card, you can fill out the form and generate a customized invoice. If you pay by credit card, an invoice will be emailed to you once your payment has been processed. If you have any problems, please contact Kristy Weinshel, Director of Membership at kristy.weinshel@utc.org or 202.833.6815.

Full Name
Title
Company
Address 1
Address 2
City
State
Zip or Postal Code
Country
Email
Phone
Fax
Revenues (no commas) $
Tabbing out of the Revenues field will automatically calculate your membership fee
UTC Canada membership fee is based on your holding company's total gross annual revenues for the most recent fiscal year. Your dues are calculated based on the following schedule.
If you annual revenue is:Your annual UTC Canada membership fee is:
Less than $5 Million Canadian $1,000 /year
$5 Million Canadian or above $3,000 /year
Membership Fee$



Total amount authorized: $
Please charge my:
Credit card number:
Expiration date:
Name on card:
Billing Address
(If different from above)
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