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Membership Application

Select Membership Type:

Organization Name (if applying for Organization membership):

Your Name (or name of the Designated Representative for your Organization):

Position Title:

Address:

City:

State/Province:

Postal Code:

Country:

Email Address:

Phone Number:

Fax Number:

Type of Organization
(Choose one)		 Areas of Hazardous Waste Activities
(Check all that apply below)
Government

Research Laboratory
Ministry/department

University/College

Academic department
Research Laboratory

Professional Society

Private Sector

Research Laboratory
Consulting firm
Equipment/instrumentation/chemical supplier
Waste treatment/storage/disposal facility
Waste Transport

 Organization's or Individual's activities deal with:
Hazardous Waste Research
Hazardous Waste Management

Technology Research, Development, and Application
Waste identification and characterization
Waste treatment (chemical, physical, biological, thermal, stabilization, solidification)
Land disposal, deep well injection
Waste storage and transport
Emergency response
Facility design and operation
Instrumentation and monitoring

Management
Policy, legislation, regulation, enforcement
International environmental standards and conventions

Integrated Assessments
Database development (specify type)

General Systems Studies

Risk Assessments
Toxicology
Environmental audits
Environmental impact assessments
Waste surveys and inventories

Pollution Prevention, Reuse, and Recovery

Remedial Activities
 Contaminated site characterization
Remedial technologies and remediation processes
Remedial alternative analysis

Other (please specify)

Current Projects

(Please give a descriptive title for all current active hazardous waste projects.)

Staff and Facilities

Number of Professional staff involved in hazardous waste activities :

Special hazardous waste facilities and equipment (please list):

Does this organization...

Conduct hazardous waste activities with its own staff and facilities?
Direct and/or financially support hazardous waste activities in other organizations?

Is the information generated by your research/activities...

Proprietary
Non-Proprietary
Some of each

Are the research results...

Published in the open literature (e.g. journals and conference proceedings)?
Published in internal organization reports that are publicly available?
Not publicly available?

Click the "Submit" button once to submit your Consortium Membership Application electronically.

THIS IS NOT A SECURE FORM.

ELECTRONIC SUBMISSIONS ARE NOT ENCRYPTED.

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