2015
Membership Application
Professional Services Council
The Voice of the Government Services Industry
Regular Membership is available to for-profit companies providing or seeking to provide professional or technology services to the federal government.
New member application Renewal Save time by renewing online at www.pscouncil.org
Associate Membership is available to companies providing services to for-profit companies furnishing professional or technology services to the federal government. Associate members must not have or seek to obtain government contracts and do not have representation on the PSC Board of Directors.
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Company Information Company Name: __________________________________________________ HQ Address: _______________________________________________________ _______________________________________________________ Main Telephone: ___________________________________________________ Website: ____________________________________________________________ # of Field Offices: ___________ # of Employees: ________________
Company description of 50 words or less (to appear in the online membership directory):
________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________
Which categories describe your core business? (check all that apply) c c c c c c c
Banking/Lending Cybersecurity Facilities Management & Logistics Investigation/ID Svcs. Operations & Maintenance Security Training
c
Commercial Real Estate
c Construction
c Engineering
c Environmental
Human Resources c IT Services/Solutions c Project Management c Software Development c Other _________________
c Insurance
c
c Consulting
Services
c Executive
Search Development c Marketing/PR c Risk Management c Telecommunications c Intl.
c Legal c Public c Tax
Affairs and Accounting
Business Classifications (check all that apply) Native American
Native Hawaiian
SDVO
SB
SDB
VO
WO
c 8(a)
ANC
MO
HHS
NASA
Hubzone
Other Business Classification ___________________________________
Government Customers (check all that apply) CIA
DHS c DIA
c NSA
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State
USAID
DNI
DOD
VA
DOE
DOI
DOJ
DOL
DOT
FAA
FBI
NRO
Other _______________________________________________________
Regular Membership Dues: Most recent year’s Corporatewide Gross Annual Revenue (GAR) $____________. Based on your GAR, select the dues category that defines your company:
Associate Membership Dues: Please select
the dues amount for the category that applies to your company.
Dues
Company Type
< $2.8M
$750
Financial Institutions
$2.8M - $58.8
(GAR in millions x $300)
[ex. $10M GAR = 10 x $300]
750M - $10B
$58.9M - $100M
$19,400
> $10B
$101M - $300M
$24,500
$301M - $500M
$28,200
$501M - $1B
$32,000
$1B - $4B
$34,000
> $4B
$36,000
GAR Amount
NGA
4401 Wilson Boulevard, Suite 1110, Arlington, Virginia 22203
< $750M (in assets)
Dues
$2,900 $4,500 $5,800
Law Firms 1-40 lawyers
$2,900 41-99 lawyers $4,500 > 99 lawyers $5,800 Other Professional Services Firms $5,800
P: 703-875-8059
F: 703-875-8922
www.pscouncil.org
Key Contact Information Please enter the names and contact information for the contacts that will manage your PSC membership along with the information of the functional roles listed below. Key Executives
Name
Corporate Title
Phone Number
Principal PSC Contact* Primary PSC Contact^ CEO (if not principal) Asst. to CEO CFO General Counsel *The principal point of contact is typically in a leadership role within your organization. They are the main billing contact and contact for association issues.
^The primary point of contact manages the PSC membership, is the main contact for updates to the corporate roster, and is the secondary billing contact.
Council Designations Please choose a primary contact for each of our PSC councils. Other employees can be designated online once we set up your company profile. Acquisition & Business Policy
Defense & Intelligence
International Development
Civilian Agencies
Technology
Contact:_______________
Contact:_______________
Contact:_______________
Contact:_______________
Contact:_______________
Title:__________________
Title:__________________
Title:__________________
Title:__________________
Title:__________________
Email:_________________
Email:_________________
Email:_________________
Email:_________________
Email:_________________
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Acceptance Affairs of the Professional Services Council are conducted in accordance with our Charter, Bylaws and Code of Professional Conduct. I hereby acknowledge that I am aware of PSCâ&#x20AC;&#x2122;s Code of Conduct and agree to adhere to its terms. Dues cover one year of membership, established by the acceptance date of this application, which is subject to approval by the PSC Board of Directors. Signature ________________________________________
Title_____________________
Date ____________
Payment Information: Total Dues Enclosed: $____________ Check enclosed or in transit (make payable to Professional Services Council) Charge to Card Number: _____________________________________ Expiration date: _____________________________________ Cardholder Name: _____________________________________ Cardholder Signature: _____________________________________
PSC dues are 96% allowable for inclusion in the indirect rates of government contractors and 91% may be deducted for federal income tax purposes. According to IRS regulations, the portion of dues allocable to lobbying activity is not tax deductible. PSC estimates that 9% 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 individual assistance for your specific situation.
SUBMIT
You can also mail this form to: Professional Services Council 4401 Wilson Blvd., Suite 1110 Arlington, VA 22203 January 2015