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Advisory Membership Form

Personal Information
First Name:
Last Name:
Title:
Affiliation:
Website:
Address:
City:
State, Zip:
Email:
Phone:
Membership Payment
  • Distinguished Benefactors - $10,000
  • Benefactors — $5,000
  • Sustaining Members — $2,000
  • Supporting Members:
    • Municipalities, non-profits, non-NERC states, Northeast provinces, U.S. Territories:  $350
    • Small Businesses - Annual revenues under $1 million: $500
    • Medium Size Businesses - Annual revenues under $100 million: $1,000
    • Large Business - Annual revenues over $100 million: $1,500
    • Trade associations, and all other businesses:  $1,500

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the form, or print the completed form using your browser's "Print" button and mail with your payment to:
NERC Advisory Membership & Supporters
139 Main Street, Suite 401
Brattleboro, VT 05301

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