MEMBERSHIP APPLICATION FORM
STEP 1 - Select one of the following EICA membership levels
Each type of EICA membership covers your entire organization including all subsidiaries. There is no limit to the number of employees from your organization that may participate in EICA activities. All memberships are valid for 12 months from the date of application.
FREE MEMBERSHIP
For-profit commercial organizations or government agencies or systems that develop or use computer-based training courseware, applications, or systems in the energy industry. This membership category provides the organization with the following:
· EICA newsletter and new course announcements via email
· Below cost pricing on all courses EICA develops
Members may upgrade their membership at any time.
PREMIUM MEMBERSHIP ($7,000 per year) current value = $1,000,000+
For-profit commercial organizations or government agencies or systems that develop or use computer-based training courseware, applications, or systems in the energy industry. This membership category provides the organization with the following:
· Unlimited free rapid eLearning development services to develop new courses for your company
· 200+ free online training courses (value = $1,000,000+) including customization for your company
· All new courses developed in the future (about 100 per year) are yours free, includes free customization
· Access to EICA's Premium member web site including EICA’s membership directory
Please check the membership level for which your organization is applying:
FREE MEMBERSHIP
$7,000 (US) per year for PREMIUM MEMBERSHIP
Please check a payment method:
Invoice Me
Check Will Follow
Credit Card (please call in credit card info to: 509-734-8014)
STEP 2 - Fill out the following application form
Organization:
Mailing Address:
City/State/Zip:
Phone:
Fax:
Web URL:
E-mail Address:
Parent Company:
Subsidiaries:
We, (organization name), hereby make application to become a (membership level) member of the Energy Industry Computer Based Training Alliance.
We hereby designate the following person as the primary point of contact for our organization:
Name:
Title:
Department:
Mailing Address:
City/State/Zip:
Phone:
Cell Ph:
Fax:
E-mail Address:
In consideration for the mutual promises and payments set forth herein, the parties hereby agree as follows:
A. We understand that the payment of our membership fees is a condition that must be met by us for our membership to start or continue in EICA. We agree to notify EICA of our intent to terminate this membership within 30 calendar days after receiving an invoice for membership fees. If not so notified, the EICA understands that the applicant organization desires continued membership and will meet its financial obligation.
The amount of dues for the membership specified above:
· $7,000 (US) per year for PREMIUM MEMBER
B. We agree to e-mail or fax a copy of this completed application to the EICA and to fax or mail a signed copy of this completed application to the EICA.
APPROVAL OF MEMBERSHIP WILL BE CONTINGENT UPON RECEIPT OF SIGNED APPLICATION FORM AND MEMBERSHIP FEE UNLESS OTHERWISE NOTED
BY (Signature): ______
PRINTED NAME:
TITLE:
DATE:
STEP 3 – Send in the completed application form via email, fax, or mail
Energy Industry CBT Alliance
Att: Rick Halverson
601 N. Montana St.
Kennewick, WA 99336
phone: (509) 734-8014
fax: (509) 734-8014
e-mail: