AEA Member Questionnaire

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Thank you for providing information for your membership in the Ammonia Energy Association (AEA).

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 Elizabeth DeWolfe (edewolfe@ammoniaenergy.org), for guidance.

CONTACT INFORMATION

Who are you? (The person filling out the form).

Name*

First Last

Email*

Company / Organization*

Role / Job Title*

Country*

City*

Logo upload*

Transparent and .png preferred

Drop files here or

Max. file size: 50 MB.

Company website*

Company Boilerplate/"About us" text (200 words max)

Key Areas of Interest*

Please select 3 terms to describe the key areas of focus of your organization e.g, Fuel Cells, Storage, Innovation

Advisory Service/Consulting

Ammonia

Ammonia Production

Catalysts

Cracking

Decarbonization

Electrolysis

Energy Transition

Fertilizer

Fuel Cells

Gas Detection

Hydrogen

Innovation

Maritime

Market Development and Analysis

Offtake

Ports and Terminals

Power Generation

Power-to-X

Project Development

Renewables

Research and Development

Safety and Public Perception

Shipping and Transportation

Solar

Storage

Sustainability

Technology

Water

Wind

Company's Position in the Ammonia Value Chain*

Production

Supply Chain

Consumption

Integrated ( some or all of the above)

Other

Company's primary Industry Segment*

Existing Ammonia Producer

Project Developer / New Ammonia Producer

Technology Provider

Startup / New Tech

Consultant

Oil / Gas

Industrial Gases

Utility (Producing Ammonia)

Utility (Generating Power from Ammonia)

Other

Active LinkedIn page

Please enter a valid URL. Select + if you would like to add more active Social Media channels

Are you interested in holding an onboarding meeting with AEA staff?*

The onboarding meeting is a chance for our team to learn more about your company's projects and interests. We also like to share AEA's projects and opportunities with you.

Yes

Do you have a new product launch, development, or other news you would like the AEA to highlight?

Opportunities are not guaranteed. Please select all that you are interested in and provide more details in the next box. Newsletter article - sent to approximately 6,000 member and nonmembers each Thursday. Select articles posted on the AEA website and LinkedIn. Members' Notice - sent to AEA members each Wednesday Webinar - held once a month for members and nonmembers. Recording posted on website. Conferences are held twice a year - APAC in June and the Annual Conference in October/November. Location varies in each region.

Newsletter article

Weekly Members' Notice Spotlight article

Webinar

Conference speaking opportunity

Please describe, in general terms, the new product, development or other news indicated in the previous question that you would like covered.

AEA staff will follow up as appropriate.

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BILLING INFORMATION

Tell us more about the company joining the AEA and the type of membership you are looking for.

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Billing entity*

Legal name of company for billing purposes

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Billing address*

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Who is the Billing Contact?*

The Billing Contact handles invoicing and billing issues

Self

Other

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If Other- Please indicate*

First Last

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Email*

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Company / Organization*

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Role / Job Title*

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Country*

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City*

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Company Size

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Number of Employees*

Greater than 100

Less than 100

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Annual Revenue*

Greater than $10 million

Less than $10 million

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Most Recent Balance Sheet*

Greater than $10 million

Less than $10 million

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Membership level

Based on the information provided, your company qualifies as Large. Here are the four tiers available to Large companies:

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Your Membership Level*

We have four different membership opportunities: please select the membership level you would like to obtain

Platinum

Gold

Silver

Bronze

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Are you applying for our Small Company (less than 100 employees) option?*

Yes

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Please indicate billing preference*

Please note that membership dues cover twelve months from the date of invoice paid

Credit card

Invoice

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Thank you for your subscription. We will invoice the Billing Contact shortly

Please note that membership dues cover twelve months from the date of invoice paid

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Thank you for your subscription. Use the below link to make a credit card payment

Credit card payments can be made here.

Please note that membership dues cover twelve months from the date of invoice paid

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Company Headquarters

City & Country

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PR/Communications Contact Name

First Last

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PR/Communications Contact Email

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COMMUNICATION AND PARTICIPATION

With whom should we communicate?

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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

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If Other - Please indicate*

First Last

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Email*

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Role / Job Title*

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Country*

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City*

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Additional Membership Contacts

All 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 - Unlimited

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Are there any additional Membership Contacts you would like to add?*

Yes

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Additional Contacts

Please indicate: Name (First & Last), Email, Job Title and Country

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Alternatively, please upload additional Contacts as a .csv file

Max. file size: 50 MB.

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MEMBERS DIRECTORY

We 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.

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Would you like to be contacted through the membership directory?*

Yes

Yes - and I am happy to be contacted by non-Members as well

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If Yes - Please indicate contact details for directory*

First Last

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Email*

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Role / Job Title*

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Country*

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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 info@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 Elizabeth DeWolfe (edewolfe@ammoniaenergy.org), for guidance.

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