Ultrasonic Industry Association Membership Application

Changing the World of Medicine and Industry Through Ultrasonics

The undersigned hereby applies for membership under the following category in the
Ultrasonic Industry Association (please check one):

[    ] Sustaining     [    ] Corporate     [    ] Individual     [    ] Student     [    ] Affinity


___________________________________    ___________________________________

Print Name                             Company Name



___________________________________    ___________________________________

P.O. Box                               P.O. Box Zip Code (if different 

                                       from street address)

									   

___________________________________    ___________________________________

Street Address                         City



____________   ____________________    ___________________________________

State          Zip Code/Mail Code      Country



___________________________________    ___________________________________

Telephone                              Fax



___________________________________    ___________________________________

Web Site/URL Address                   Email Address



Sustaining members:   Please nominate (list) 5 delegates.

Corporate members:    Please nominate (list) 3 delegates.



1.  ___________________________________   ___________________________________

    Name                                  Title



2.  ___________________________________   ___________________________________

    Name                                  Title



3.  ___________________________________   ___________________________________

    Name                                  Title



4.  ___________________________________   ___________________________________

    Name                                  Title



5.  ___________________________________   ___________________________________

    Name                                  Title



Note:  Please complete below if any of the nominated delegates have a different

       address, telephone number/fax number or Email address.



__________   ____________________________________________________________

Delegate #   Address



___________________________________________   __________   ______________

City                                          State        Zip Code/Mail Code



_________________________   _________________________   _________________

Telephone                   Fax                         Email

Sustaining Member       Dues: $765/year

Manufacturer or purchase of ultrasonic equipment and related items for sale or use.
This is a sustaining membership category. Companies in this category receive a
Membership Certificate, are listed by company name in the UIA Directory and can nominate
5 delegates as voting members.

(Note: Sustaining members may designate additional individuals for voting rights at
a 20% discount from the Individual Member dues. These additional memberships will be
listed under the corporate name of the sponsoring company.)

Corporate Member       Dues: $305/year

A company, division or institution that uses ultrasonic equipment, does research, or
provides services, in the field of ultrasonics to the ultrasonic field or which supplies
equipment, materials or services, which are not of an ultrasonic nature, to ultrasonics
manufacturers or users. Companies in this category are listed by company name in the UIA
Directory and can nominate 3 delegates as voting members.

Individual Member       Dues: $115/year

A person with an interest in the field of ultrasonics. Individual members have the right to
vote on matters pertaining to the association. They receive all member benefits. This type
of membership is listed by personal name rather than by company in the UIA Directory or other
publications of the Association.

Honorary Member       No dues required

An individual, selected by and approved by the Board of Directors, who has made significant
contributions in the field of ultrasonics. This type of membership receives all communications
from the association but does not have voting rights.

Affinity Member       No dues required

Professional or trade organizations sharing common interests with the UIA and with whom reciprocal
organizational membership arrangements have been established. This type of membership has no voting
rights but does receive the quarterly newsletter of the association.

Student Member       Dues: $40/year

Students enrolled at an academic institution in a degree program in science, engineering, or
technology may apply for this type of membership. They may form chapters of the Association
and such chapters may nominate additional students for such membership. This type of membership
has no voting rights but does receive the quarterly newsletter of the association. Student membership
shall terminate automatically upon graduation or withdrawal from said academic institution.

Members Outside North America (excluding Student Members)       Foreign mail cost: $60/year

In addition to applicable membership dues, foreign members are subject to the above additional
cost for mailing.


Dues are payable upon invoicing at the beginning of the year.
Members joining during the second half of the year shall pay dues on a semiannual basis for the
remaining part of the calendar year.
Example: January 1 - June 30 = full dues; July 1 - December 30 = 1/2 dues




If elected to membership, the applicant and/or company delegates agree(s) to comply with the
Ultrasonic Industry Association’s Bylaws and to promote the welfare of the Association. The applicant
has also completed the Membership Applicant Profile form. 



_________________________________   _________________________________

Signed (required)                   Title



_________________________________   _________________________________

Name (print or type)                Date

Payment Information:   Amount Due $______________
Check Enclosed: [    ] Please charge my: [    ] Visa    [    ] Mastercard 



____________________________  _____________  _________________________

Account Number                Exp. Date      Cardholder Name




In order to consider/approve your Membership Application, a company/individual
profile must accompany the membership Application.

Briefly describe below the nature of the company/individual activities in
ultrasonics. Note company size, products, and services. A company annual
report or individual resume can be provided.





Profile:  ___________________________________________________________________



_____________________________________________________________________________



_____________________________________________________________________________



_____________________________________________________________________________



_____________________________________________________________________________



_____________________________________________________________________________



_____________________________________________________________________________



Areas of Activity/Interest
Please Check All That Apply
Agglomeration     Materials/Components     UIA Committees:    
Atomization     Medical     Standards/Regulations    
Biological     Mixing     Membership    
Biological Cell Disruption     Orthopedics     Education    
Cavitation     Power Supplies/Generators     Newsletter    
Ceramic Crystals     Sensing     Directory    
Ceramics Piezoelectric     Soldering     Symposium    
Cleaning     Sonochemistry     Board of Directors    
Compaction     Sonoluminescence          
Defoaming     Streaming          
Degassing     Surgical          
Dehydration     Titanium Metal          
Dental     Transducers     Other Areas of Interest:    
Fatigue     Ultrasonic Cutting          
Homogenization     Ultrasonic Measurement          
Homogenization     Ultrasonic NDE          
Horns/Boosters/Tools     Welding Films/Fabrics          
Laboratory     Welding Metals          
Levitation     Welding Plastics          
Machining Ultrasonics     Other:          


Ultrasonic Industry Association
PO Box 2307
Dayton OH 45401-2307 USA

Phone: +1-937-586-3725
Fax: +1-937-586-3699

For additional information please email UIA Headquarters.

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