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Department:Phone:

Department:Phone:

Application Company Profile: Company Name:Headquarter Address: Headquarter Phone:

Company’s w.! Primary Contact: Title:           Email

Company’s RBA Secondary Contact: Title:           Email:

Please describe your company’s electronics related business: 

Membership Category and Annual Dues Level  ‐ Annual dues are based on the company’s current annual revenue. New members pay a one‐time $5,000 application fee. For more information on membership categories, please visit the RBA website or contact the RBA at membership@ResponsibleBusiness.org.The Responsible Business Alliance membership year begins on January 1 and ends on December 31. Eligibility - RBA membership is open to companies that manufacture or contract the manufacture of a product in which electronics is a function of the product, or supply materials used in those goods.  Membership Category (Choose one):  

Supporter

Full Member

Dues Level (Choose one):  

US $35,000 (revenue less than $9B)

US $45,000 (revenue more than $9B)   

Number of Employees (All locations, choose one) 

1‐499 5,000‐9,999

500‐999 10,000‐49,999   

1,000‐4,999    50,000 +

Questions? Contact RBA Member Services1725 Duke Street, Suite 300 Alexandria, Virginia, USA 22314 membership@ResponsibleBusiness.org Tel. 571‐858‐5733 

Please select the applicable categories that best describe your company’s business:

Primary Secondary Tertiary

Assembly test

Electronics components

Manufacturing services / contract manufacturer

Extractives / mining

Joint design manufacturer

Logistics

Manufacturing equipment

Original design manufacturers

Original equipment manufacturer

Recycling operations

Retailer

Semiconductor manufacturer

Services

Smelter / refiner

Software

Storage

Technology re-seller

Other (please write in):

2021 w.! Membership Application Form 

1) Application must be complete and include signed commitment letter (see sampleon following  page)

2) Submit completed application form and commitment letter to:membership@ResponsibleBusiness.org

For more information, please visit: www.NJŜǎLJƻƴǎƛōƭŜōdzǎƛƴŜǎs.org or Contact staff at membership@ResponsibleBusiness.org 

Please tell us about your interest in RBA membership:

AffiliateRegular Member

Member Sponsor (if applicable) (Current RBA member who may have encouraged or required your company to join):____________________________________________

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Sample Commitment Letters to accompany  completed RBA Membership Application Form

Commitment letters should be on company letterhead

For Affiliate, Member and Full Member Categories

Date

Address

Dear RBA Board of Directors,

On behalf of (insert company name) and in support of our application for RBA membership, I am writing to state my company’s commitment to supporting the RBA's mission, vision, bylaws, membership requirements and the Code of Conduct. In addition, our company is committed to meeting all the requirements of membership as outlined in the Membership Compliance Program.

Sincerely,

CEO (or CEO-1) Name

For Supporter Member

Date

Address

Dear RBA Board of Directors,

On behalf of (insert company name) and in support of our application for RBA membership, I am

writing to state my company’s commitment to supporting the RBA's mission and vision, bylaws and

membership requirements.

Sincerely,

Company representative