Member Onboarding | Life Science Washington

Organization Name *

Organization Website / URL

Organization Description *

Organization Address *

Address Line 1

Address Line 2

City

State

Zip Code

*Please ensure your company address can accept mailed invoices. We do not accept PMBs at UPS, messenger collectives or other shipping stores, or virtual addresses.

WA State UBI

If your organization is doing business in Washington state, please provide the business’ UBI.

Year Founded

Layout Email Organization

Total Number of Employees *

Number of Employees in Washington State *

Primary Contact *

First

Last

Please provide a primary contact that we can contact and will have access to our member portal.

Primary Contact Email *

*We require your organization issued email unless your organization is new and hasn’t established emails.

Primary Contact Phone *

Billing Contact – Is your billing contact different than your primary contact? *

Yes
No

Billing Contact *

First

Last

Billing Contact Email *

Billing Contact Phone *

Is your site head/regional manager/CEO different than your primary contact?

Yes
No

Site Head/Regional Manager/CEO *

First

Last

Site head/Regional Manager/CEO Email *

Do you have a human resources person different than your primary contact?

Yes
No

Human Resources Head *

First

Last

Human Resources Head Email *