MEMBERSHIP REQUEST
 
First Name*
 
 
Last Name*
 
 
 
Job Title*
 
 
 
Email Address*
 
 
Business Phone*
 
 
 
 
Organization*
 
 
Referred By
 
 
USA Owned & Based?*
 
 
D-U-N-S Number*
 
 
Website*
 
 
Entity Type
 
 
 
Address 1*
 
 
Address 2
 
 
 
City*
 
 
State/Province*
 
 
Zip Code*
 
 
 
Please note payment in the form of Cost Share or a combination of Cost Share and Cash requires additional documentation and approval. If you have not already completed the Cost Proposal Template and received approval on the same please contact Joe Veranese at joe.veranese@ncdmm.org before submitting this form. Approval must be received prior to proceeding with the America Makes membership process.
Proposed Payment Type*
 
 
Proposed Membership Level*
 
 
 
Sponsored?*
 
 
If Yes, Sponsored By
 
 
 
 
 
 
 
Describe primary additive manufacturing technology and America Makes Interest*
 
 
Technology fit with America Makes Mission*
 
 
Describe prior interaction with America Makes and/or NCDMM*
 
 
What benefits will your organization provide America Makes in the future*