MEMBER REGISTRATION Membership Application Name* First Last Title*Phone*Organization Name*Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Type of Organization?*Please select one, even if more than one applies.HealthcareCultural or ScientificHigher EducationDisability AgencyPublic EntityPrivate SchoolReligiousSenior LivingMunicipalityHousing AuthorityOtherEnergy supply used by organization?*Please check as many as apply. Electricity Gas Oil Propane Steam Your organization's total annual electricity and natural gas costs?*PowerOptions annual membership dues are based on your organization's total annual electricity and natural gas costs (regardless of which energy products purchased through PowerOptions), which we use as a reflection of the size of your organization. Please check the box corresponding to your organization's energy costs and return the form with the appropriate annual dues, payable to PowerOptions. Under $10,000 ($125 annual dues) $10,000 - $100,000 ($250 annual dues) $100,000 - $500,000 ($550 annual dues) $500,000 - $1,000,000 ($1,000 annual dues) Over $1,000,000 ($2,500 annual dues) For Solar-Only Members:In the following year, after Solar System is in operation, members shall pay annual dues as listed above. Please check the appropriate box above. Small System Solar (300 kW or less) $500 one-time dues Large System Solar (above 300 kW) $1,000 one-time dues As a PowerOptions member, your organization agrees to:*• Have its name listed as a potential purchaser of power or other energy products and services; • Provide necessary information on energy usage and billing to PowerOptions® or its selected energy supplier; • Appoint a senior-level contact person; • Receive and fairly consider the PowerOptions® energy supply and services arrangements. Your institution is not required to make a purchase, and this form is not to be construed as an obligation to contract for energy or services through PowerOptions®. I understand and accept.