2013 PSC Regular Membership Application

Professional Services Council

The Voice of the Government Services Industry NEW MEMBER APPLICATION—Regular Membership Regular Membership in the Professional Services Council is available to for-profit companies or firms engaged in the business of furnishing professional or technical services to the Federal Government.

Company Information

Please provide your company information as it should appear in PSC’s internal membership database and membership list.

Company Name____________________________________________________________________________________ Parent Company___________________________________________________________________________________ Company Address__________________________________________________________________________________ Main Telephone ___________________________________ Main Fax________________________________________ Web Address______________________________________________________________________________________ Year Established______________________ # of Field Offices_____________________ # of Employees_____________ Please attach company description (of 25 words or less).

Key PSC Contacts Principal Contact__________________________________ Title____________________________________________ Address__________________________________________________________________________________________ Telephone________________________________________ FAX____________________________________________ E-mail Address____________________________________________________________________________________ Assistant’s Name, Telephone, and E-mail Address_________________________________________________________ Alternate Contact__________________________________ Title____________________________________________ Address__________________________________________________________________________________________ Telephone________________________________________ FAX____________________________________________ E-mail Address____________________________________________________________________________________ Assistant’s Name, Telephone, and E-mail Address_________________________________________________________ *Primary Contact__________________________________ Title____________________________________________ Address__________________________________________________________________________________________ Telephone________________________________________ FAX____________________________________________ E-mail Address____________________________________________________________________________________ Assistant’s Name, Telephone, and E-mail Address_________________________________________________________ *The Primary Contact is the Individual whom you wish to manage your company’s membership with PSC.

4401 Wilson Boulevard, Suite 1110, Arlington, Virginia 22203

P: 703-875-8059

F: 703-875-8922

www.pscouncil.org

Key Executives* Name

Corporate Title

Phone Number

E-mail

CEO/President Asst. to President CFO COO General Counsel Head of Contracts Head of HR Head of Govt. Relations Head of PR/Communications Head of Business Development *For PSC internal classification use. Please list actual corporate titles in the space provided.

Classification

Special Status (i.e. small business, woman-owned, hub-zone)______________________________________________________

Financial Information

(This information will only be used for membership management and the generation of aggregated industry statistics.)

Please note gross annual receipts from the following during your most recent fiscal year: Federal Government

$________________

Commercial

$________________

International

$________________

State/Local Government

$________________

Other

$________________

TOTAL

$________________

Dues Structure Gross Annual Receipts Less than $2.8 Million

Amount of Dues

$2.8 Million to $58.8 Million

Gross Annual Receipts x $300 = Your Dues

$58.8 Million to $100 Million

$19,400

$101 Million to $300 Million

$24,500

$301 Million to $500 Million

$28,200

$501 Million to $1 Billion

$32,000

$1 Billion to $4 Billion

$34,000

Greater than $4 Billion

$36,000

$750 Example: $17.3 x $300 = $5,190

Acceptance Dues cover one year of membership in PSC. The date your original application is received is your renewal date for subsequent years. New member applications are subject to the approval of the PSC Board of Directors.

Amount of Dues Enclosed $_________________________ Affairs of PSC are conducted in accordance with our Charter, Bylaws, and Code of Professional Conduct. I hereby acknowledge that I am aware of PSC’s Code of Conduct and agree to adhere to its terms.

Payment information Payment information Credit card number ______________________________________________________________________ Expiration date ____________________ Security code _________________________________________ Signature______________________________ Title_______________________________ Date____________________ PSC dues are: • 96% allowable for inclusion in the indirect rates of government contractors and • 89% may be deductible for federal income tax purposes. (According to IRS regulations, the portion of dues allocable to lobbying activity is not tax deductible. PSC estimates that 11% of your dues is allocable to lobbying activities and, therefore, not deductible.) Dues paid to PSC are not deductible as charitable contributions. Please consult your tax advisor for January 2013 individual assistance for your specific situation.