HomeMy WebLinkAboutCORRESPONDENCE - PURCHASE ORDER - 91507432
MEMBER INFORMATION:
'('00LORAU0 WATER
INNOVATION CLUSTER Lt�ibOS
Company/Organization Name: City of Fort Collins
PRIMARY CONTACT:
Name: Joshua Birks
Title: Economic Health Director
E-mail: jbirks@fcgov.com
Order
Vendor/Supplier
OV # Batch #
Aoct #
Phone: 970-221-6324
ANNUAL DUES: (Please select the appropriate membership category)
k Corporate Level 1 ($5,000) - US Revenues > $loom
❑ Corporate Level 2 ($3000) - US Revenues >=$10M<$l o0M
❑ Corporate Level 3 ($1000) - US Revenues>=$.5M<$loM
❑ Corporate Level 4 ($500) — US Revenues <$.5M
❑ Government ($5000) - Typically cities with utilities departments XXX
❑ Academic ($5000) — Research Universities
❑ Association, Nonprofit, Small Government ($500)
Organizations may include:
• Small government (may not directly provide water services) such as counties
--- • Associations that represent their members, such as ditch companies
• Nonprofits/Social Enterprise
• Teaching universities
❑ Individual ($100) Can be used where another member type may not be appropriate for the current year
❑ Student ($25) Must be enrolled at a University during the current year
PAYMENT:
4
❑ Check # Enclosed. (Payable to CWIC) fAmount:
❑ Paid Online through Paypal: Date: www.co-waterinnovation.com
THANK YOU FOR YOUR CONTINUED SUPPORT OF CWICII
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