SMART Enrollment Forms

Enrollment Forms

For SMART Membership questions, contact Bob Carullo at  609-304-2904 or bcarullo@smartstates.com

ANNUAL MEMBERSHIP APPLICATION
Level of Membership (Please check one or delete others) Date:
Business
– Large Business (501 + employees) $5,000.00
– Small Business (201 to 500 employees) $1,000.00
– Small Business (11 to 200 employees) $500.00
– Micro Small Business(1-10 employees) $200.00


Academia
– Universities $1,000.00
– Colleges $500.00
– Schools $250.00

Government 

– States, Office of the Governor $50,000.00
– Federal Executive Branch HQs $5,000.00

– Fed Labs/Field Agencies $1,000.00

 State Agencies / Major Cities $1,000.00

 Cities / Counties $500.00

Annual period is from date of application; contact Bob Carullo for membership questions at 609-304-2904 or bcarullo@smartstates.com If an invoice is needed, contact Bob. Please copy and paste this completed form in an e-mail to pamifillion@comcast.net
To pay by check, please make check payable to SMART and mail to:
Pamela Fillion, SMART Treasurer
17 Crested Butte Court
Shamong, NJ 08088-8227
If paying by credit card, complete below and mail to above or e-mail; we complete a credit card transaction for the amount listed above:
a. Card Type (AMEX, VISA, etc): 
b. Full Name on Card:
c. Account Number:
d. Expiration Date:
e. Security Code:
f. Billing Address:
Company Name:
Number of Employees:
Website:
Mailing Address:
Contact Name:
e-mail:
Phone: Fax:

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