Company/Organization InfoCompany/Organization Name* Parent Company/Organization President/CEO* Key Contacts*Please include at least one key contact; add more people with whom we can communicate about your company's membership.First NameLast NameEmail Address Title* Email* Phone*Marketing/ Communications contact and email* Address* Street Address Address Line 2 City Select a StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address Same as above Street Address Address Line 2 City Select a StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website*Please include the "http" or "https" Twitter Account Number of Employees*Industry*select oneAudio/VisualAdvertising/MarketingAgricultureBankingBiotechnologyChemicalsComputers/HardwareConstructionConsultingEducationElectronicsEnergyEngineeringEnvironmentalFinanceFood & BeverageGovernmentHealthcareHospitalityInsuranceIT ServiceLegalManufacturingMediaMed TechNot for ProfitOtherReal EstateSoftwareStaffing/SearchTelecommunicationsTransportationVenture CapitalWeb DevelopmentMembership InformationAssociation Involvement Activities*Membership dues apply to all employees. Becoming active in MnTech is the best way to get a return on your investment. Please let us know how you would like to be involved in MnTech programs, events and initiatives by checking up to three (3) activities. Attend Events/Networking Visibility within community Marketing/Sponsor events Professional Development Advocacy/Public Policy – Federal Advocacy/Public Policy – State Advocacy/Public Policy - Local STEM Education Sales/Business Development Membership Category*select oneTechnology ProducersTechnology Application UsersAncillary Service FirmsNonprofits & Public EntitiesTechnology Producers*Examples Include: Manufacturing, software, engineering, telecom, datacom, consulting. After selecting your category, please select your company’s Minnesota gross revenues.select one$0 - $100k$100k - $500k$500k - $1m$1m - $2m$2m - $5m$5m - $10m$10m - $25m$25m - $50m$50m - $100m$100m - $250m$250m+Technology Application Users*Examples Include: Sales and service organizations, utilities, financial institutions. After selecting your category, please select your company’s Minnesota gross revenues.select one$0 - $500k$500k - $2m$2m - $5m$5m - $10m$10m - $25m$25m - $50m$50m - $100m$100m - $250m$250m+Ancillary Service Firms*Examples Include: Legal, accounting, venture firms, real estate. After selecting your category, please select your company’s Minnesota gross revenues.select one$0 - $500k$500k - $2m$2m - $5m$5m - $10m$10m - $25m$25m - $50m$50m - $100m$100m - $250m$250m+Nonprofits & Public Entities*Examples Include: Economic development organizations, government agencies, educational institutions. Please select your organization's annual budget.select one$0 - $500k$500k - $2m$2m - $5m$5m - $10m$10m - $25m$25m - $50m$50m - $100m$100m - $250m$250m+MnTech DuesMembership dues are based on gross annual revenue from your most recent fiscal year, or for nonprofits & public entities, your annual budget. $0.00 Payment InformationMethod of PaymentInvoice MeCheckCredit CardBilling Address Street Address Address Line 2 City Select a StateAlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Billing EmailPlease enter the email address of an individual to receive the payment confirmation email. Credit Card Information American ExpressDiscoverMasterCardVisaSupported Credit Cards: American Express, Discover, MasterCard, Visa Card Number Expiration Month010203040506070809101112 Expiration Year20232024202520262027202820292030203120322033203420352036203720382039204020412042 Expiration Date Security Code Cardholder Name NOTE: For federal tax purposes, a portion of your payment may be deductible as an ordinary business expense. However, the portion allocable to lobbying activities is not. Using methods required by federal regulations, we reasonably estimate this portion of your annual dues payment to be 12%.MnTech Dues $0.00 CAPTCHA