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:
*
Select
United States
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Bouvet island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo (Brazzaville)
Congo (Kinshasa)
Cook Islands
Costa Rica
Croatia
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Lands
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard and McDonald Islands
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liechtenstein
Lithuania
Luxembourg
Macao
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
Reunion
Romania
Russian Federation
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
South Africa
South Georgia and South Sandwich Islands
Spain
Sri Lanka
Suriname
Svalbard and Jan Mayen Islands
Swaziland
Sweden
Switzerland
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad And Tobago
Tunisia
Turkey
Turkmenistan
Turks And Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Virgin Islands, British
Virgin Islands, U.S.
Wallis And Futuna Islands
Western Sahara
Yemen
Zambia
Postal Code:
*
Company Website:
*
Number of Employees Corporate-wide:
*
Global Revenue:
*
$
Please include total revenue for your parent company in US Dollars
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)
First Name
*
Last Name
*
Title:
*
Phone
*
E-mail
*
Government Relations Contact
First Name
Last Name
Title:
Phone
E-mail
Training Contact
-
(the key contact for training of staff)
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
*
©
2021
IPC International, Inc. | 3000 Lakeside Drive, 105 N, Bannockburn, IL 60015 | PH 847-615-7100 | FAX 847-615-7105