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NWEC Membership Application
Please complete this form by March 15, 2018 in order to be considered at the April 25, 2018 membership meeting, where the full membership will consider potential organizational members.

Please provide as much information as possible. With approval of your application, the non-confidential aspects of this form will be used to fill in your member profile in our database and our membership directory.

Membership Dues: The below information will also be used to calculate your organizational membership dues. The Coalition will notify you of your organizational dues estimate prior to the full membership meeting on April 25, 2018.

If you have questions, please contact Kat Plimpton at 206-621-0094. After receiving this application, we will follow-up with you regarding next steps in the application process.

Full organizational name *
Your answer
Abbreviation/acronym
Your answer
Full mailing address *
Your answer
Billing address (if different from mailing address)
Your answer
Phone *
Your answer
Organizational website *
Your answer
Geographic scope (which cities, states, regions or countries does your organization or company work in?) *
Your answer
Annual revenue for non-utility businesses (will be kept confidential, this information is collected to determine your appropriate dues level)
Number of staff in your organization: (for non-profits only, this information is collected to determine your appropriate dues level)
For electric utilities only: about how many Kwh sold annually? (will be kept confidential, this information is collected to determine your appropriate dues level)
For gas utilities - about how many millions of therms sold annually? (will be kept confidential, this information will be used to determine your appropriate dues level)
Your answer
Name of organizational representative (This is the main contact person for your organization/the person who will normally attend Coalition meetings representing your organization.) *
Your answer
Email of organizational representative *
Your answer
Phone number of organizational representative *
Your answer
Title of organizational representative *
Your answer
Name of alternate organizational representative (the backup contact person in case the organizational representative is not available) *
Your answer
Email of alternate organizational representative *
Your answer
Phone number of alternate organizational representative *
Your answer
Title of alternate organizational representative *
Your answer
In 2 - 3 paragraphs describe how the activities of your organization or company shares the goals of the Coalition (http://www.nwenergy.org/about-the-coalition/) *
Your answer
Any additional information you would like to provide:
Your answer
My organization/company agrees to support the NW Energy Coalition's mission to advocate a clean and affordable energy future for the region based on: meeting all new energy demand with energy efficiency and new renewable resources; full and fair accounting for the environmental effects of energy decisions; protecting and restoring the fish and wildlife of the Columbia River Basin; consumer and low-income protection; and informed public involvement in building a clean and affordable energy future. *
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