AEA Member Questionnaire AEA Member Questionnaire "*" indicates required fields Step 1 of 6 16% Thank you for providing information for your membership in the Ammonia Energy Association (AEA). The survey has four sections: Contact Information: Basic information about the personal out filling the form Marketing Information: Logo upload, boilerplate/“About us” text, company website Communication and Participation: Contact for communication purposes, key account holders, newsletter subscription Members Directory: Consent to take part in the new Members-only section of the AEA website Please refer to our website for more details on our different Membership levels. Through this survey the AEA aims to gather all relevant information to deliver the full benefits of your membership. If you have any questions or are unsure about any items in the survey, please contact our Office Administrator Ella Krupa (ekrupa@ammoniaenergy.org), for guidance.CONTACT INFORMATIONWho are you? (The person filling out the form).Name* First Last Email* Company / Organization* Role / Job Title* Country* City* HiddenBILLING INFORMATIONTell us more about the company joining the AEA and the type of membership you are looking for. HiddenBilling entity*Legal name of company for billing purposes HiddenBilling address* HiddenWho is the Billing Contact?*The Billing Contact handles invoicing and billing issues Self Other HiddenIf Other- Please indicate* First Last HiddenEmail* HiddenCompany / Organization* HiddenRole / Job Title* HiddenCountry* HiddenCity* HiddenCompany Size HiddenNumber of Employees*Companies with less than 100 employees qualify for our "Small Company" membership fee tier Greater than 100 Less than 100 HiddenAnnual Revenue* Greater than $10 million Less than $10 million HiddenBalance Sheet* Greater than $10 million Less than $10 million HiddenMembership levelYou can find more information about AEA membership levels & pricing here.HiddenYour Membership Level*We have four different membership opportunities: please select the membership level you would like to obtain Platinum Gold Silver Member HiddenAre you applying for our Small Company (less than 100 employees) option?* Yes No HiddenPlease indicate billing preference*Please note that membership dues cover twelve months from the date of invoice paid Credit card Invoice HiddenThank you for your subscription. We will invoice the Billing Contact shortlyPlease note that membership dues cover twelve months from the date of invoice paidHiddenThank you for your subscription. Use the below link to make a credit card paymentCredit card payments can be made here. Please note that membership dues cover twelve months from the date of invoice paid MARKETING INFORMATIONPlease provide the following information about your organization for display on our website. Member Name*Company name as you'd like displayed Company Headquarters*City & Country Logo uploadTransparent and .png preferred Drop files here or Select files Max. file size: 64 MB. Company website* Company Boilerplate/"About us" text (200 words max)Key Areas of focusPlease provide 3 or more words to describe the key areas of focus of your organization e.g, Fuel Cells, Storage, InnovationKeyword 1Keyword 2Keyword 3 Add RemoveActive LinkedIn pagePlease enter a valid URL. Select + if you would like to add more active Social Media channels Add RemovePR/Communications Contact Name First Last PR/Communications Contact Email COMMUNICATION AND PARTICIPATIONWith whom should we communicate?Who is the Key Account Holder?*The Key Account Holder is in charge of making decisions on behalf of the Member. This person authorizes membership renewal, designates committee participants, and votes in AEA elections Self Other If Other - Please indicate* First Last Email* Role / Job Title* Country* City* Additional Membership ContactsAll other key employees who should have access to AEA Member Benefits. These individuals will be invited to register as users of the Member Area of the website and will receive member notices such as event invitations, working group announcements, discount codes, etc. All Member Contacts (including the Key Account Holder) are subscribed to our weekly email newsletter Different Membership tiers are able to add different numbers of additional Contacts, as follows: Members - 2 additional Contacts Silver Members - 5 Gold Members - 10 Platinum Members - UnlimitedPlease indicate your Membership tier* Members Silver Gold Platinum Are there any additional Membership Contacts you would like to add?* Yes No Additional ContactsPlease indicate: Name (First & Last), Email, Job Title and Country Alternatively, please upload additional Contacts as a .csv fileMax. file size: 64 MB. MEMBERS DIRECTORYWe are currently developing a Members-only section of our website with resources, opportunities for committee involvements and a directory you can use to contact your fellow Members. Please note that personal information will not be displayed in this directory. Messages between Members will be sent via feedback forms and facilitated by the AEA team. Although focused on Member-to-Member contact to begin with, we would like to extend this service to non-Members as well. Please indicate below if you would be happy to be contacted via a publicly-available directory.Would you like to be contacted through the membership directory?* No Yes Yes - and I am happy to be contacted by non-Members as well If Yes - Please indicate contact details for directory* First Last Email* Role / Job Title* Country* Is there anything in particular you’d like to see included in this new website section that would enhance your membership experience with AEA? Privacy Notice: The information provided will be held in compliance with GDPR regulations. This questionnaire is entirely voluntary and you can withdraw all information at any time. All data provided in this form will be strictly used for the purpose of delivering benefits of membership. Information will be handled, stored and used only by the Ammonia Energy Association. For further information please contact Alexandra Johnson (ajohnson@ammoniaenergy.org)* I agree to the privacy policy. THANK YOU FOR COMPLETING OUR QUESTIONNAIRE - PLEASE SUBMIT USING THE BUTTON BELOW!If you have any questions or are unsure about any items in the survey, please contact our Stakeholder Relations Manager, Andrea Guati Rojo (aguatirojo@ammoniaenergy.org), for guidance.