New Member (Partner) Organization Application

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Contact Information for Member ORGANIZATION Application
NOTE: ESIP does NOT have individuals as members. All ESIP members are organizations. If you have a question, email Bruce Caron: brucecaron@esipfed.org  for more information before filling out this form.
1. Primary Contact
2. Designated Assembly Representative (if different from primary contact)
3. Please add any alternate or proxy assembly representatives, if available.