My organization would like to be considered for membership in the American Brain Coalition as a:

______Non-Profit Member

Brain-related patient advocacy organizations representing patients and families, joined with professional scientific and clinical organizations representing researchers and clinicians, constitute the non-profit member category.

Non-profit Members Fee Structure

Members will be encouraged to pay the below dues structure. This fee structure is based off approximately 0.1% of an organization’s total revenue. If an organization feels they are being incorrectly billed, or if for some reason they believe that total revenue is not an accurate measure of their organization’s resources, they should provide a written statement to the ABC Membership Committee, explaining what annual contribution best reflects their organization’s true budget.

  • Organizations with $10 million or more in total revenue will be asked to provide an annual contribution of $15,000.
  • Organizations with $7.5-10 million in total revenue will be asked to provide an annual contribution of $10,000.
  • Organizations with $5-7.5 million in total revenue will be asked to provide an annual contribution of $7,500.
  • Organizations with $3.5-5 million in total revenue will be asked to provide an annual contribution of $5,000.
  • Organizations with $2-3.5 million in total revenue will be asked to provide an annual contribution of $3,500.
  • Organizations with $1-2 million in total revenue will be asked to provide an annual contribution of $2,000.
  • Organizations with $500-1 million in total revenue will be asked to provide an annual contribution of $1,000.
  • Organizations with less than $500,000 in total revenue will be asked to provide an annual contribution of $500.

______Corporate/For-profit Members

Corporations that support the ABC’s mission, as well as maintaining a working relationship with ABC non-profit members, constitute the corporate/for-profit membership category.

Corporate/For-profit Members Fee Structure

  • Members will pay an annual contribution of $15,000.
  • Members will participate in a Corporate Advisory Committee (CAC). Each CAC member may recommend one member to the Nominating Committee for consideration as nominees to serve on the Board of Directors.
  • One CAC representative shall be invited to sit on the ABC Board of Directors, but will not receive a Board vote.
  • Members will receive advocacy updates.
  • Members will have the opportunity to participate with non-profit members in quarterly conference calls on hot topics such as health care reform or comparative effectiveness research.
  • Corporate/For-profit members must adhere to the PHARMA and/or AVAMED Code of Conduct.

______Observer

Government agencies may be invited or request permission to participate in meetings and conference calls; observers do not have any voting rights, are not required to make any type of financial contribution, and are not members as defined by ABC bylaws.

My Organization’s Contact Information:

Organization: ______

Main Contact & Title: ______

Legislative Contact (if different from main contact): ______

Address: ______

City/State/Zip Code: ______

Phone: ______Fax: ______Email: ______

Web site: ______

Please email or send this form to:

Katie Sale, Executive Director

American Brain Coalition

6257 Quantico Lane N.

Maple Grove, MN 55311

(763) 557-2913