Company/Organization InfoCompany/Organization Name*Parent Company/OrganizationPresident/CEO*Key Contact Name* First Last Title*Email* Phone*Marketing/ Communications contact and email*Address* Street Address Address Line 2 City Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Mailing Address Same as above Street Address Address Line 2 City Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Website*Please include the "http" or "https" Twitter AccountNumber 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 MHTA is the best way to get a return on your investment. Please let us know how you would like to be involved in MHTA 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. 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+MHTA DuesYour annual MHTA dues are based on your estimated 2019 Minnesota gross revenue. $0.00 Payment InformationMethod of PaymentInvoice MeCheckCredit CardBilling Address Street Address Address Line 2 City Select a StateAlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest 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 ExpressDiscoverMasterCardVisa Card Number Expiration Month010203040506070809101112 Expiration Year20202021202220232024202520262027202820292030203120322033203420352036203720382039 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%.MHTA Dues $0.00 This iframe contains the logic required to handle Ajax powered Gravity Forms.
