IPC Membership Renewal Form

*Indicates required field.

Member Dues

Please review Member dues before finalizing this form.

Membership/Renewal Information

Term of renewal:*

1 Year

2 Years

3 Years

Renewal Invoice/Document Number:

Payment Amount: * $

Member Company Information

Company Name:*

Please enter Organization

Company Name Variations:*

List all company, parent company or division names used in the last five years. Please include any merger or acquisition name changes so we can update our records.

Please enter a value for Company Name Variations.

Number of Employees Corporate-wide:*

Please enter the number of employees corporate-wide

Global Annual Revenue:* $

Please provide global annual revenue in US Dollars. Company global annual revenue is subject to
review and verification.

Please enter the Global Revenue for your company.

Primary Category:*

Please select Primary Category

Company Website:*

Please enter the Company URL

Company Accounts Payable Email:*

Please enter the Company Accounts Payable Email Address

Primary Membership Location

Mailing Address:*

Please enter mailing address

City:*

Please enter city

State/Province:*

Please enter state

Country/Region:*

Please select country

Postal Code:*

Please enter postal code

Membership Billing Contact - (the key contact for invoices and statements)

First Name:*

Please enter your first name

Last/Surname Name:*

Please enter your last name

E-Mail:*

Area Code/Phone:*

Please enter area code and phone number

Billing Address Information for Membership

Billing Address is same as above