WBIA
Membership Application
WisconsinBioIndustry
A l l i a n c e
Member Information
ORGANIZATION/BUSINESS: ADDRESS:
CITY:
*PRIMARY CONTACT: EMAIL: WEBSITE:
STATE: TITLE:
ZIP:
PHONE:
*If you would like additional staff members (aside from the primary contact) to receive WBIA communications, please attach a separate list of additional contacts including names, titles and emails.
Membership Support Level
Please select a membership level by checking the appropriate box: Founding Member ($2,500 per month) Elite Member ($10,000 annually)
Associate Member ($5,000 annually)
Supporting Member ($2,500 annually)
Benefits associated with each level and their descriptions can be found on our Member Benefits information page. If you have any additional questions, please feel free to contact Joshua Morby at info@wisconsinbioindustry.com or by calling (414) 344-1733.
5027 West North Avenue, Milwaukee, Wisconsin 53208 414.344.1733 • www.wisconsinbioindustry.com • info@wisconsinbioindustry.com
WBIA
Membership Application
WisconsinBioIndustry
A l l i a n c e
About the WBIA
The Wisconsin Bio Industry Alliance is a nonprofit corporation that supports the development of biobased renewable energy, power, and products in Wisconsin. By bringing the appropriate players to the table, the organization will grow the bio-economy in Wisconsin, concentrating on a specific series of campaigns targeted at the most fertile opportunities in Wisconsin.
The WBIA is a 501(c)3 nonprofit tax-exempt organization. Contributions to the Wisconsin Bio Industry Alliance meet the IRS eligibility requirements for tax deductions to nonprofit organizations.
Submit Your Application
To join the WBIA please submit this signed form with your membership support check made payable to The Wisconsin Bio Industry Alliance. Please send the completed form and your payment to: Wisconsin Bio Industry Alliance 5027 West North Avenue Milwaukee, WI 53208 Phone: (414) 344-1733 info@wisconsinbioindustry.com
Signature: Thank you for your support!
Date:
5027 West North Avenue, Milwaukee, Wisconsin 53208 414.344.1733 • www.wisconsinbioindustry.com • info@wisconsinbioindustry.com