The Voice of the Government Services Industry

Professional Services Council

NEW MEMBER APPLICATION—Associate MembershipAssociate Membership in the Professional Services Council is available to organizations which do not qualify for regular membership (for-profit companies engaged in the business of furnishing professional or technical services to the government) but which provide commercial or investment banking services; venture capital, investment analysis or other investment services; legal services; or other services to the professional and technical services industry. Associate members have no voting privileges and do not qualify for representation on the Board of Directors.

Company InformationPlease provide your company information as it should appear in PSC’s internal membership database and membership list.Company Name ___________________________________________________________________________________

Parent Company __________________________________________________________________________________

Company Address _________________________________________________________________________________

Main Telephone __________________________________ Main Fax _______________________________________

Web Address _____________________________________________________________________________________

Year Established______________________ # of Field Offices_____________________ # of Employees ____________Please attach company description (of 25 words or less).

Key PSC ContactsPrincipal Contact _________________________________ Title ___________________________________________

Address _________________________________________________________________________________________

Telephone _______________________________________ FAX ___________________________________________

E-mail Address ___________________________________________________________________________________

Assistant’s Name, Telephone, and E-mail Address ________________________________________________________

Alternate Contact _________________________________ Title ___________________________________________

Address _________________________________________________________________________________________

Telephone _______________________________________ FAX ___________________________________________

E-mail Address ___________________________________________________________________________________

Assistant’s Name, Telephone, and E-mail Address ________________________________________________________

*Primary Contact _________________________________ Title ___________________________________________

Address _________________________________________________________________________________________

Telephone _______________________________________ FAX ___________________________________________

E-mail Address ___________________________________________________________________________________

Assistant’s Name, Telephone, and E-mail Address ________________________________________________________ *The Primary Contact is the Individual whom you wish to manage your company’s membership with PSC.

4401 Wilson Boulevard, Suite 1110, Arlington, Virginia 22203 P: 703-875-8059 F: 703-875-8922 www.pscouncil.org

Key Executives* Name Corporate Title Phone Number E-mail

CEO/President

Asst. to President

CFO

COO

General Counsel

Head of Contracts

Head of HR

Head of Govt. Relations

Head of PR/Communications

Head of Business Development

*For PSC internal classification use. Please list actual corporate titles in the space provided.

Dues Structure for Associate MembersOther Professional Services Firms

m Other professional services firms pay annual membership dues in the amount of $5,800.

AcceptanceDues cover one year of membership in PSC. The date your original application is received is your renewal date for subse-quent years. New member applications are subject to the approval of the PSC Board of Directors.

Amount of Dues Enclosed $ ________________________ Affairs of PSC are conducted in accordance with our Charter, Bylaws, and Code of Professional Conduct. I hereby ac-knowledge that I am aware of PSC’s Code of Conduct and agree to adhere to its terms.

Payment information

Credit card number _________________________________________________________________

Expiration date ____________________ Security code ____________________________________

Signature ________________________________________ Title_______________________________ Date _________

PSC dues are:• 96% allowable for inclusion in the indirect rates of government contractors and • 89% may be deductible for federal income tax purposes. (According to IRS regulations, the portion of dues allocable to

lobbying activity is not tax deductible. PSC estimates that 11% of your dues is allocable to lobbying activities and, therefore, not deductible.)

Dues paid to PSC are not deductible as charitable contributions. Please consult your tax advisor for individual assistance for your specific situation. January 2013

Financial Institutions (Dues for financial institutions are based on the institution’s assets as outlined below.)Select one: Assets Amount of Duesm < $750 million in assets $2,900m $750 million to $10 billion in assets $4,500m > $10 billion in assets $5,800

Law Firms (Dues for law firms are based on the firm’s number of lawyers as outlined below.)

Select one: Assets Amount of Duesm 1–40 lawyers $2,900m 41–99 lawyers $4,500m 100 or more lawyers $5,800