AMERIPEN Membership Renewal and Billing Confirmation Form

AMERIPEN Membership Renewal and Billing Confirmation Form – Action Requested by October 3

To support our budgeting process and ensure accurate billing for 2026, all members are asked to complete this form by October 3, 2025. Thank you for your timely submission.

If you have any questions, please reach out to our team at info@ameripen.org.

Fields marked with an * are required.

Membership Renewal Status

Organization *

Please indicate your membership status for 2026: *

My organization will be renewing its membership in AMERIPEN

My organization will not be renewing its membership in AMERIPEN

Membership Tier & Dues

Please confirm your membership type, tier, and dues for 2026: *

Associate Member | $7,800

Company Member - Tier 1 (Global sales greater than $10 billion for most recently reported fiscal year.) | $30,000

Company Member - Tier 2 (Global sales of $1–10 billion for most recently reported fiscal year.) | $22,800

Company Member - Tier 3 (Global sales of $10 million–1 billion for most recently reported fiscal year.) | $15,000

Company Member - Tier 4 (Global sales of less than $10 million for most recently reported fiscal year.) | $7,800

Primary Contact Information

First Name *

Last Name *

Title

Email *

Phone *

Billing Information

Billing Contact First Name *

Billing Contact Last Name *

Billing Contact Title

Billing Contact Email *

Billing Contact Phone *

Accounts Payable Process/Notes (if applicable): *

If your organization uses a third-party invoice processing system, please indicate which system and describe process here. If not applicable, please write in "N/A."

PO Number *

If a PO number is required by your organization, please list the PO number here for us to include on your invoice. If a PO number is not required, please enter "N/A."

AMERIPEN Membership Renewal and Billing Confirmation Form

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