CleanTECH San Diego Member Application

Contact Name *
Position *
Company Name *
Company Address *
City *
State *
Zip *
Direct Phone *
Email *
Website *
Number of Employees *
Membership Expectation *
Brief explanation of what you hope to gain during your membership (i.e. lead generation, credibility, involvement, visibility, knowledge of programs /incentives, and general knowledge).
Products/Services *
Describe your company specialty.
Background *
Brief background of the company foundation, current production, and goals for the future.
CleanTECH Classification (please "X" all that qualify):
Choose one of the following for each below:
Target Market:
Member Level:
Committee Interests:
Reference Projects/Clients: *
Topical Event Preferences (i.e. solar, wind, networking, grant writing, investment, etc.):
Image verification: *
Please, type the code you see in the image below:

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