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 Emily Carbone, Membership Coordinator or by phone 703-841-3293.

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NEMA Committees & Coalitions Application