Membership Application

The U.S. Payments Forum is an integral part of the Secure Technology Alliance. Membership in the Alliance entitles participation in all forums and joint committees focused on technologies and vertical markets. Completing this application form serves as a letter of intent by the organization listed above to join the Alliance and participate in the U.S. Payments Forum, a cross-industry body that addresses a variety of payments technologies that protect the security of, and enhance opportunities for payment transactions within the U.S. The Secure Technology Alliance bylaws define five membership levels. Select the appropriate membership level you intend to join. Please carefully review the membership levels and each level’s benefits and any restrictions associated with each level.

"*" indicates required fields

This will serve as a letter of intent of the organization listed below and hereinafter referred to as Prospective Member, to join the Secure Technology Alliance, a not-for-profit multi-industry member organization, with rights, privileges and responsibilities detailed in the bylaws of the Secure Technology Alliance. All items marked with asterisk (*) are required.

Organization Details

Organization Name*

Website*

Address*

Please provide logo

Please attach logo (Max file size 512MB - .jpg .gif .png .pdf)

Accepted file types: jpg, gif, png, pdf, Max. file size: 700 MB.

Provide Short Description of Company*

Permission to include company name on membership lists for general marketing purposes*

Yes

Permission to provide link from Secure Technology Alliance site to your organization's website*

Yes

Member qualifications and benefits vary by membership level as described at Membership Information : Membership Levels. Membership dues are based on member’s annual revenue.

Annual Revenue*

Select Desired Membership Level

Leadership (revenue = dues)

<$100 Million = $14,000

$100 Million-$1 Billion = $18,000

>$1 Billion = $20,000

Global Payment Networks = $30,000

Principal (revenue = dues)

General (revenue = dues)

Associate

All government agencies, colleges & universities, and industry associations = $2100

Individual

Student = $50

Individual = $1,200

Acknowledgment*

The prospective member intends to join the Secure Technology Alliance at the membership level indicated above and agrees to the annual dues. Payment terms are 30 days from the date of submitting this application. The Secure Technology Alliance membership year runs for one year starting with the first day of the month joined and renews automatically on the anniversary date unless prior notice of cancellation is provided in writing. The Secure Technology Alliance does not lobby, and no allocation of dues is necessary for tax purposes.*

Bylaws Agreement*

I acknowledge that I have read the Secure Technology Alliance bylaws at Membership Information : Bylaws and Policies, meet the qualifications for the membership level selected, and agree to the Terms and Conditions of the Secure Technology Alliance.*

Details of your Industry, Products Offered, and Markets Served

Industry Classification*

(Select all that apply)

Other

Products Offered*

(Select all that apply)

Other

Other Devices

Markets Served*

(Select all that apply)

Other

Government Agencies Served

Payment Details

Upon approval of the application, the Alliance will send the new member an electronic invoice. Payment may be made by credit card, wire transfer, or check. Instructions for each payment method will be included with the electronic invoice.

Member Primary Point of Contact

Name*

Title*

Email address*

Work Phone*

Mobile Phone

Fax

Alternate Point of Contact

Name*

Title*

Email address*

Work Phone*

Mobile Phone

Fax

Please list the referring Secure Technology Alliance member that led you to join, if applicable

Name

Company

If you have any questions or issues while filling out the form, please email Deb Ferril: [email protected] or download the application and email to Deb Ferril.

Comments

This field is for validation purposes and should be left unchanged.

Membership Application

Membership Application

Organization Details

Select Desired Membership Level

Details of your Industry, Products Offered, and Markets Served

Payment Details

Member Primary Point of Contact

Alternate Point of Contact

Please list the referring Secure Technology Alliance member that led you to join, if applicable

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