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NYBA:
Membership Application
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Membership Application
Note: Items in marked with asterisk(
*
) are required
General Information :
Please provide the following information:
*
Corporate Title
Title can not be left blank.
*
Primary Contact's First Name
First Name can not be left blank.
*
Last Name
Last Name can not be left blank.
*
Email Address
Email Address can not be left blank.
Email Address must be valid.
*
Name of Organization
Name of Organization can not be left blank.
*
Mailing Address
Address can not be blank.
*
City
City can not be blank.
*
State, ZIP
AK
AL
AR
AZ
CA
CO
CT
DC
DE
FL
GA
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MI
MN
MO
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
RI
SC
SD
TN
TX
UT
VA
VT
WA
WI
WV
WY
14-4000 Liege
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Northwest Territory
Nova Scotia
Nunavut
Ontario
Prince Edward Island
Saskatchewan
Yukon Territor
Quebec
Zip can not be blank.
*
Telephone
Telephone can not be blank and must be valid format.
Fax
WWW Address
*
Description of Business
Business Description can not be left blank.
*
Business Sector
--Please Select--
Accounting
Advertising/Public Relations
Biotechnology/Pharmaceuticals
Consulting
Contract Manufacturing
Contract Research
Economic Development
Financial
HR/Staffing Firms
Insurance
Law
Real Estate
Research Institutions
Suppliers
Utility
Please Select Category
*
Business Sector Subcategory
--Please Select--
Please Select Subcategory.
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Only JPG,PNG,JIF images are allowed!
Membership Categories:
NYBA welcomes new and returning members! We divide our memberships into "Enhanced" and "Standard" levels. Please choose the appropriate membership category and level that fits your organization's needs and goals. NYBA dues are based on the calendar year. If you are not joining in January, your membership will be prorated.
Enhanced Membership Categories:
Enhanced Membership offers superior benefits (such as sponsorship opportunities, marketing and executive visibility) and comprises two categories: Sustaining Membership and Premier Membership. Organizations that choose Enhanced Membership demonstrate their clear commitment and investment in the growth of the biotechnology industry in New York by supporting legislative and regulatory efforts, life science business activities, business networking and education.
Sustaining Membership:
click to view full details
Annual Dues $50000.00
Premier Membership:
click to view full details
Annual Dues $25000.00
Standard Membership Categories:
Standard Membership is based upon an organization's business category and its total number of employees worldwide (not simply total employed in New York State or in a particular practice area). Basic Membership benefits include a broad range of services and offerings.
Core Member:
Any corporation, partnership, association or other entity that develops, manufactures or commercializes drugs, pharmaceuticals, agricultural products, industrial or environmental products based upon the practical applications of the biological sciences. Membership dues are based upon the total number of employees worldwide (not simply the total employed in New York State).
< 5 employees
Annual Dues $800.00
5 to 19
Annual Dues $1300.00
20 to 49
Annual Dues $2000.00
50 to 99
Annual Dues $3500.00
100 to 199
Annual Dues $5000.00
200 to 499
Annual Dues $7000.00
500+
Annual Dues $9000.00
Support Member:
Organizations that provide services, equipment, supplies or other products of benefit to the biotechnology, pharmaceutical, biomedical or bioengineering industries (including law and consulting firms, investment groups, employment agencies, international economic development agencies, real estate firms, etc.) are eligible to join NYBA as Supporting Members. Membership dues are based upon the total number of employees worldwide (not simply total employed in New York State or in a particular practice area).
< 10 employees
Annual Dues $1500.00
10 to 49
Annual Dues $2500.00
50 to 99
Annual Dues $4000.00
100 to 199
Annual Dues $5500.00
200 to 499
Annual Dues $7500.00
500+
Annual Dues $9000.00
Institutional Member:
Institutional Members include any non-profit institution, research laboratory, academic medical center, university, or government body with an interest or involvement in biotechnology. Member benefits extend to all administrators, employees, students, etc. of the institution.
All
Annual Dues $2500.00
Please select membership category.
Please provide names of people in your organization:
Business Development
Name :
Email :
CFO
Name :
Email :
Human Resource
Name :
Email :
Purchasing Department
Name :
Email :
Communications Director
Name :
Email :
Title
Name :
Email :
Add another contact
*
Enter Anti Spam Code (Case Sensitive)
Please Enter Anti Spam Code.
Payment Information:
Please note: if you would prefer to give us your credit card number over the phone, please check the below check-box and we will contact you. If you are paying by check, your membership is effective once payment has been received.
*
Payment Type
Select Payment Type
Credit Card
Check
Please Select Payment Type.
*
Account Number
Account Number can not be blank.
*
Expiration (mm/yyyy)
Expiration Date can not be blank and must be valid.
Expiration Date can not be blank and must be valid.
*
Cardholder's Name
Cardholder's Name can not be blank.
*
Amount Authorized to Charge
Amount Authorized to Charge can not be blank.
*
Account Number
Account Number can not be blank.
*
Routing Number
Routing Number can not be blank.
*
Check Number
Check Number can not be blank.
*
Account holder Name
Account holder Name can not be blank.
*
Amount Authorized to Charge
Amount Authorized to Charge can not be blank.