APS: Corporate Membership Application

Please complete the application below and click submit at the end of your application. Once you have submitted your application a copy will be available for you to print and send with your payment. A complete copy of your application will also be emailed directly to our office so that we can expedite your acceptance.

Applicant Company Name:
Mailing Address:

City:
State/Province (If applicable):
Country:
Postal Code:

Telephone Number (including country code):
Fax Number (including country code):
Website (if applicable):
Please Describe the type of Productivity Consulting work that your firm performs:

Number of Productivity Consulting Professionals:
Number of Officers and Administrative Personnel:
Locations of any other Offices for this Company:
Principle Territory(ies), Region(s), or Country(ies) in which this company operates:
Officers:
Chief Executive Officer:
E-mail Address:
Chief Marketing Officer:
E-mail Address:
Chief Financial Officer:
E-mail Address:
Chief Operating Officer:
E-mail Address:
Other Officers:
Corporate Directors:
Is your company/organization owned or affiliated with any other consulting or productivity implementation firm?	Yes No
If yes, please advise the name, address, phone and fax numbers for that company:
Type of Membership (Select one):	Local Company (Operating in one state, province or country) @ $1,500 USD per year
	Regional Company (Operating in a number of countries such as North America or Europe) @$2,500 USD per year
	Global Company (Operating across more than one continent) @ $4,000 per year.