Member Representative Name: Employer: Position or Title: Business Address: City: State: Zip: Business Tel: Business Fax: E-mail Address: Website:
Provide names of up to four (4) additional people (with email addresses) within your organization that may wish to obtain information about BioNorthTX: Name 1: E-mail 1: Name 2: E-mail 2: Name 3: E-mail 3: Name 4: E-mail 4:
Please list name of person responsible for purchasing in your company: E-mail: Phone Number:
Please check if applicable: Yes, please list my company name and website in the BioNorthTX website membership directory
Please check off areas of interest to you and your company regarding costs savings through the THBI/BIO Business Solutions national purchasing program. This discount program is a free member benefit. Savings will exceed the cost of your BioNorthTX membership! TriNet HR & Health Benefits SolutionsBioSurplusElsevier Business IntelligenceFedEx ShippingFedEx Deep Frozen ShippingThe Linde GroupTechDepot by Office DepotShare VaultVWR Lab SuppliesBusiness WireOffice DepotTechDepotAPPI Energy ConsultingChubb Business InsuranceInformaHumboldt Moving & Storage
Please indicate below what membership category your company falls into for verification of annual membership dues.
— select category — 1 – 10 employees $35011 – 20 $75021 – 100 $1,500101-250 $2, 500251-500 $3,000501 or more $4,500 1 – 20 employees $1,00021 – 100 $2,500101 – 250 $3,500251 or more $5,000 Non-Profit trade group $350University/Research Institution $1,500 <40M Research ExpendituresUniversity/Research Institution $3,000 >40M Research ExpendituresUniversity/Research Institution $5,000 >75M Research ExpendituresHospitals/Clinics $3,000 Student $35Job Seeker $75Individual $150
Life Science Members – All dues based on total number of full-time employees worldwide. Definition: Companies and organizations that working in fields that include: Research, Biotechnology, Medical Device & Equipment, Pharmaceuticals & Therapeutics, Nanotechnology, Diagnostics, and Product Development/Drug Discovery Firms.
Associate Members – All dues based on total number of full-time employees worldwide. Definition: Companies and institutions that are not directly involved in commercial biotechnology/life science product development or commercialization, but share an interest in the industry’s future and provide service or products to Life Science companies. Examples: Professional Services (consulting, law, insurance, HR Solutions. marketing, VC & investment firms, financial services, real estate, site selection, product sales & distribution, service IT providers, etc.), Health & Life Science IT (Medical Records, R&D, Wellness, Revenue Cycle, etc.), Contract Research (Clinical & Pre-Clinical Trials, Trial Data Management), Marketing, Sales, Laboratories & Testing Services, etc.
Institutional Members – All dues based on total number of full-time employees worldwide. Definition: Institutions and organizations involved with bioscience research & development, care delivery, education, and advocacy, Clinics/Hospitals, Colleges/Universities, Research Institutions, Non-Profit Disease Related groups or industry trade associations/professional organizations.
Individual members Definition: Individuals, job seekers and students interested in the life science industry
We would like to contribute the following amount above our association membership dues, to benefit the further development of BioNorthTX $ .
On behalf of my organization, I hereby apply for membership in BioNorthTX and to pay all membership dues promptly at renewal. I will also ensure that other individuals at my organization are aware of the benefits of membership. If I am to leave my organization, I will notify BioNorthTX of my replacement as Member Representative. Date: Signed:
Please return this form with a check payable to BioNorthTX, 1400 Civic Place, Suite 221, Southlake, Texas, 76092. Or, you may request an electronic invoice for payment by Credit Card or PayPal. Send electronic invoice Check enclosed in the amount of $
BioNorthTX is designated as a 501(c)(6) trade association. Membership dues may constitute a business expense but are not a charitable deduction at this time.