NEMA Committees & Coalitions Application

The Association of Electrical Equipment and Medical Imaging Manufacturers

Committees & Coalitions Name:

Company Name:

Headquarters Address:

City:

State:

Zip Code:

NEMA Full Member
NEMA Associate Member
Non-Member

Primary-Voting Representative – Participates in the Committees & Coalitions and has the voting rights for the company. There is only on Primary-Voting Representative per company.

Primary-Voting Representative Name:

Primary-Voting Representative Title:

Primary-Voting Representative Address (if different from above):

Primary-Voting Representative City:

Primary-Voting Representative State:

Primary-Voting Representative Zip Code:

Primary-Voting Representative Phone:

Primary-Voting Representative Email:

Alternate-Voting Representative – Participates in the Committees & Coalitions and can vote should the Primary-Voting Representative be unavailable.

Alternate-Voting Representative Name:

Alternate-Voting Representative Title:

Alternate-Voting Representative Address (if different from above):

Alternate-Voting Representative City:

Alternate-Voting Representative State:

Alternate-Voting Representative Zip Code:

Alternate-Voting Representative Phone:

Alternate-Voting Representative Email:

Applicant will be invoiced for Committees & Coalitions Membership. Invoice will be sent to the Primary-Voting Representative. To change billing contact in the email please send billing contact’s name, address, telephone number and email.

Questions, contact Brittany Seabury, Senior Director, Member Recruitment and Engagement or by phone 703-841-3266.

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NEMA Committees & Coalitions Application