Becoming an Industry Member within the IPA is an invaluable resource to receive the most up-to-date research, exposure to various networking opportunities, and to enhance overall business development. COMPANY INFORMATION: * Company Name:   * Address:   * City:   * State:   * Zip Code:   * Work Phone:   Fax: Web Site:   COMPANY REPRESENTATIVE INFORMATION: * First Name:   * Last Name:   * Email Address:   * Password:   * Phone  (include country code & area code):   Department: Position: Check here if you would like to receive our Newsletter.     GENERAL INFORMATION: What is your company’s primary interest in Prebiotics and/or Probiotics? Probiotic-Fortified Foods and BeveragesProbiotics for Animal Health Yogurt/Kefir/Cultured DairyProbiotic Manufacturing Technologies Cultured Soy Marketing of Probiotic Products Fermented Vegetables or GrainsPre or Probiotic Ingredients Supplier Pre and Probiotic Supplements Prebiotics (FOS/Inulin, Gums, Fiber, Resistant Starch) Probiotic Products for Infant Health Other:   Below please state your approximate Total Annual Revenue (TAR) from Probiotic products and then instruct our membership dues here TAR:   PAYMENT INFORMATION: For payment of membership dues, you may wire the funds directly to the IPA Bank Account * or you may send a check made out to the International Probiotics Association and send it to: International Probiotics Association 684 Lee St, Suite #4099 Des Plaines, IL 60016 USA Upon request, we can email or send you an invoice for this payment of membership dues. We will automatically email a receipt of payment to the contact person listed on the membership application. * If you wish to wire your payment directly to the IPA, please email Ioannis Misopoulos at ioannis@internationalprobiotics.org to request the IPA Bank Wire Information Form. Upon completion of this form, email to: membership@internationalprobiotics.org Or Fax to: 847-298-5348