ATAT Membership Form

RESNA Standards Committee on Assistive Technology for Air Travel (ATAT) Membership Application & Renewal Form

Contact Information

Company Name

Parent Company (if applicable)

Corporate Website

Brief Description of Organization

Primary representative name

First Name

Last Name

Title

Address

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Phone

Alternate representative name

First Name

Last Name

Title

Address

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Phone

Financial contact name (for invoicing, if different than primary rep)

First Name

Last Name

Title

Address

Address Line 1

Address Line 2

City

State/Province

ZIP / Postal

Country

Phone

Interest Category

Please indicate the interest category that best applies to you and/or your organization (select only one):

Please specify:

Member Category & Administrative Fee

Please indicate your member category (choose one) and check your administrative fee:

For companies and organizations, please check the category that best applies to your company and/or product:

Fee Schedule

RESNA Assistive Technology Standards Committee membership is based upon a calendar-year billing cycle. An interested party may join at any time. Future billing
cycles will begin on January 1 of each subsequent year.

Administrative Fee

Administrative fees for Government, Educational and Individual Members are a flat rate.

Administrative fees for a Company or Organization are based on the type of business and the number of employees in the business.

The fee structure for each industry is based on the number of standards and the volume of work required to manage the specific standards development activities.

Annual global sales revenue (optional)

Number of employees

Annual administrative fee to RESNA based on the category chosen above

For International Wire Transfer, please add $35.00 processing fee

Number of Committees* in which your company intends to participate (submit separately)

*Discounts apply for companies participating on multiple committees: 10% Discount for 2 committees 20% Discount for 3 or more committees

Payment Method

Choose one of the following payment methods

A check made out to RESNA Online payment ACH/Wire

Bank Name: CIBC Bank USA

Bank Address: 120 South LaSalle Street Chicago, IL 60603

ABA: 0710-0648-6

SWIFT Code: PVTBUS44

Favor of (“F/O”): RESNA

Account (“A/C”): 2642085

Notice

We are in accord with the purposes and principles of RESNA and wish to join a RESNA Assistive Technology Standards Committee as a member. We also agree to provide a minimum of 60-days notice prior to our renewal date should we elect to terminate membership.

Name

First Name

Last Name

Signature

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Date/Time