Membership Application

PDF APPLICATION MEMBER BENEFITS MEMBER LEVELS

Company Name :

Address :

City/State/Zip :

Main Contact

Contact Name :

Contact Address :

Contact City/State/Zip :

Phone :

Fax :

Contact Title :

Contact Phone :

Contact Email :

Application Type :
NewRenewal

Company Description

This information will be posted on our www.montanabio.org website in the membership directory section and will introduce you to our other members in our newsletter. Please limit your description to 125 words.

Description :

Company Representative for the Online Directory (please list at least one)

Name/Title 1 :

Phone 1 :

Email 1 :

Name/Title 2 :

Phone 2 :

Email 2 :

Name/Title 3 :

Phone 3 :

Email 3 :

Membership Levels (Annual Fee)

Yellowstone Member

Select the applicable level below:

$150 – Individuals* (students, retirees, persons seeking employment)$150 – Emerging Bioscience Companies** (biotech, pharma, & medical device)$500 – Fewer Than 10 Company Employees (including all small consulting firms)

* People with a company or other organization are not eligible to join as individuals.

** There is a 2 year limit to the emerging company category. After 2 years the membership rate will
increase to the next appropriate level.

Glacier Member – (up to $5,000 based on number of employees)

Select the applicable level below:

$1500 – 10‐25 Employees$2500 – 26‐75 Employees$5000 – 76‐100 Employees

Big Sky Member

Select the applicable level below:

$15000 – 101+ Employees

After submission, we will start your application process. Please send check for applicable fee to:
Montana Bioscience Alliance, PO Box 1773, Billings, MT 59103

Membership Application

Review Membership Levels & Benefits