NVTC Affiliate Member Application



*Company Name:


*Primary Contact:


*Title:


*Email:


*Address:


*City/State/Zip:


*Phone:


Fax:


Website:


Have you ever attended an NVTC event? No Yes

*Required fields

Please provide names and correct titles for:

Name Title Email


Others to receive newsletter and events calendar:

Name Title Email


Whom may we thank for recommending NVTC to you?

Referred by Referring Company Date Referred


Do you wish to be contacted about the following?

Advertising opportunities
Sponsorship opportunities
The NVTC Foundation
NVTC Veterans Employment Initiative

Committee interest?

Big Data and Analytics
Business Development, Marketing & Sales
CFO Forum
Cybersecurity and Privacy
Data Center & Cloud Infrastructure Committee
Health Technology
HR & Benefits Committee
HR Steering Group
International
NextGen Leaders
Small Business and Entrepreneur
Tech Law and Procurement Committee
Technology Innovations
Workforce and Education


Company Demographics

Has your company been a member before?

Is your company public or privately owned?

Services and products your business is directly engaged in (not the services of your clients).

Primary business category.

Secondary business categories (optional – select all that apply).

Accounting
Advertising/Marketing
Aerospace
Architecture
Associations
Banking
Bio-IT
Bio-Medical
Chemical
Commercial Real Estate
Communications / PR
Computer Hardware
Consulting
Cybersecurity
Defense
Education/Training
Electronics
Employment Services
Energy
Engineering
Environmental
Environmental/Green IT
Finances
Government Contractor
Govt Affiliation
Health Care
Hotels/Restaurant
Information Systems
Infrastructure Solutions
Insurance
Inter/Intranet Integration
International
Internet Service Provider
Investment Services
IT Security
IT Services
Law
Manufacturing
Media
Modeling/Simulation
Multimedia
Nanotechnology
Nonprofit
Nuclear
Other - Associate
Other - Technology
Pharmaceutical
Professional Services - Associate
Professional Services - Technology
Research and Development
Retail
Software
System Integration
Technical Services
Telecommunications
Telemedicine
Transportation
Venture Capital
Website Design


Does your company do business internationally?


URL of your company's international information:

Description of company:



Payment Information

Payment information must be included for application to be completely processed. If sending a check, please print and mail application to NVTC. Otherwise, complete payment information below.

Total number of full-time employees in VA, DC and MD   

*Total Investment Amount:   $ 

Credit Card: MasterCard   Visa   American Express

Card Number:      Exp. Date:

Name on Card:

Please note: This is an encrypted ssl page, however, if you prefer not to send your card information over the Internet, please print and mail.

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If printing and mailing application, mail to:
Northern Virginia Technology Council
2214 Rock Hill Road, Suite 300 Herndon, VA 20170
attn: Membership Department

Note: On some systems, data entered into online forms may not print with document, and you may need to fill out the printed form manually.

* The following is NOT intended to provide tax advice -- you should rely upon only your tax advisor to do so. Dues paid to NVTC are NOT deductible as charitable contributions. A portion of dues paid to NVTC may be deductible for federal income tax purposes as a business expense, although according to IRS regulations the portion of dues allocable to lobbying activity is not tax deductible and NVTC estimates that 28% of your dues is allocable to the public policy lobbying activities of NVTC and is therefore not deductible.