IPC and WHMA Membership Application

Member Company Information

Company Name:*

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)

Primary Membership Location

Street Address:*

City:*

State/Province:*

Country/Region:*

Postal Code:*

Company Website:*

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.

IMPORTANT: Enter only whole numbers in this field; no decimal places and no commas.

Is the above location the corporate headquarters?*

Yes No

Primary Membership Contact

First Name:*

Last Name:*

Title:*

Phone:*

E-Mail:*

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

Same as Primary Membership Contact

First Name *

Last Name *

Title:*

Phone *

E-mail *

Government Relations Contact

Same as Primary Membership Contact

First Name

Last Name

Title:

Phone

E-mail

Training Contact - (the key contact for training of staff)

Same as Primary Membership Contact

First Name

Last Name

Title:

Phone

E-mail

To best serve your specific needs, please indicate the most appropriate member category(s) for your company.

Primary Company Category * (choose one) PCB EMS OEM Wire Harness Manufacturer Design Services Government College/School Certification Center Software Developer Consulting Group Supplier Other	Secondary Company Categories (select all that apply) PCB EMS ODM OEM Wire Harness Manufacturer Design Services Software Developer Consulting Group Supplier Other

Industries you serve (select all that apply) Aerospace Automotive/Transportation Communications Infrastructure Equipment Consumer Technology Defense/Military Energy/Industrial E-Textiles Medical/Instrument Recreational (RV, Marine, OPE & RTV) Semiconductors Off-Highway Other

Membership Selection
NEW! Receive 50% off your first year for first time members! Past membership will be verified upon receipt of your application.

Has your company been an IPC Member in the past?*

Yes No

Select Membership Type*
(View Membership Options)

Company Membership
Online Standards Subscription Membership (using third party partner)

Select Membership Duration*

1 Year Membership
2 Year Membership (10% discount)
3 Year Membership (15% discount)

Amount Due: $ 0.00

(View Membership Dues Table)

Method of Payment

I am paying by check

Make check payable to IPC and mail to the lock box address below:

IPC
3491 Eagle Way
Chicago, IL 60678-1349

I am paying by wire transfer (U.S. funds)

Include your company name and reference IPC MEMBERSHIP

Wire Transfer Instructions
ACH:
071000013
IPC Account Number:
18231861

Domestic Wire Transfers
Wire Routing Number/ABA: 021000021
Bank Name: JP Morgan Chase Bank, N.A.
City, State: New York, New York
Account Number: 18231861
Title of Account Number: IPC

International Wire Transfers
Wire Routing Number/ABA: 021000021
SWIFT CODE: CHASUS33
Bank Name: JP Morgan Chase, N.A.
City State: New York, New York
Account Number: 18231861
Title of Account Number : IPC

Pay with credit card



	Please check here if you require an official invoice from IPC.
Form Submitted By
Please enter your contact information below. Email confirmation of this application will be sent to the email address below.
First Name *
Last Name *
Phone *
E-mail *