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INDUSTRIAL RESEARCH INSTITUTE, INC.

APPLICATION FOR MEMBERSHIP

(For confidential use by Board of Directors and Membership Committee)

The IRI membership year is a calendar year, January 1 to December 31. Membership dues for 2011 are $11,450 if paid by 1/15/11 are $11,800 if paid after that date and include two registrations each to the Annual Meeting and to the Member Summit. Please contact IRI at membership@iriweb.org, or call 703.647.2580. If you wish to apply for membership and your organization meets the eligibility requirements, you may print the Membership Application or the Associate Membership Application (for qualifying federal labs), fill in, and fax to IRI at 703.647.2581 or fill out the online membership form below.

Is your organization a government or federal lab? No Yes

Company Name:
Principal products and / or services:
Industrial classification of company businesses (express as percent of total)
Aerospace Industrial Machinery & Equipment
Chemicals & Advanced Materials Industrial Products not listed elsewhere
Communications, Telecom Networks, &/or Systems Paper & Allied Products
Computer & Computer Related Products Personal Care
Consumer Products not listed elsewhere Petroleum & Related Products
Electronics Primary Metal Industries
Fabricated Metal Products Professional & Scientific Instruments
Food, Tobacco, & Related Products R&D Services
Genetic Engineering/Molecular Biology Textile Products & Apparel
Healthcare, including Medical Products & Pharmaceuticals Transportation & Public Utilities
Other
We will designate the following persons to represent the company in IRI:
VOTING REPRESENTATIVE (VR) ALTERNATE REPRESENTATIVE (R)
Name: Name:
Title: Title:
Company: Company:
Address: Address:
Address2: Address2:
City: City:
State: State:
Zip: Zip:
Phone: Phone:
Fax: Fax:
Email: Email:
Website: Website:
(Optional) If the VR is not the CTO or equivalent of your company please fill in the following information about the CTO of your company:
Name:
Title:
Phone:
Fax:
Email:

Our designated Voting Representative is qualified to represent our research, development and/or engineering functions, authorized to participate in all activities of the Institute, and to vote on our behalf.
  We certify that our company is a firm, institution, or other organization offering primarily commercial products or services. Our business purpose is the creation, production, and commercial offering of physical or intellectual products or services based on technological innovation including research, development, design, introduction, and technical support of products or services. We certify that our company has 20+ degreed, technical personnel and performs $5+ million US dollars in Research & Development.
Submitted By:
Email:
Title:

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IRI 2010 Member Summit

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October 26-28, 2010

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