Below you will find the membership application forms for joining the Gaming Standards Association.

11/09/2009Membership Application FAX formPDF

Please contact us at sec@gamingstandards.com or 510-492-4060 for additional membership information.

MEMBERSHIP APPLICATION

Company Information
Company name: Zip:
President / CEO: Country:
E-mail: Phone:
Company address: Fax:
City: Web site:
State:    
If your company is publicly traded, and you give permission to GSA to use your ticker symbol in GSA press releases, list it here:
Check the box that best describes
your primary business:		 Manufacturer
Operator
Other:
What is your company’s reason for joining GSA?
Has your company or any of its officers, directors or principals ever been subject to a gaming license revocation or suspension investigation or proceeding in any jurisdiction?
YES NO

Provide a description of the proceeding, when it occurred, its current status or outcome and any other relevant information:
Do you have any reason to believe that if your company applied it may be denied a gaming license in any jurisdiction for any reason?
YES NO

Identify and fully describe the reason for such belief:
Does your company conduct gaming related business in any jurisdiction where gaming is not regulated by a governmental agency or were gaming is not subject to governmental licensure?
YES NO

Identify all such jurisdictions and the nature of the business your company conducts in such jurisdictions:
 
  Membership Class and Fees
Platinum ($80,250) Gold ($32,100) Silver ($21,400)
GSA membership and standard licensing is based upon a calendaryear billing cycle. Applications received after July 1 will be prorated to 50% of the annual fee, providing company agrees to renew membership for the next calendar year at same or higher level. All fees are in US Dollars.
 
  Notice

Applicants agree for the duration of the applicant’s membership in GSA to fully abide by GSA bylaws, policies, rules and regulations as such can be amended from time to time hereafter. Member understands that GSA does not guarantee the availability and/or terms of any licensing agreements with third parties regarding proprietary specifications.

Applicants are notified that they must immediately make any applicable patent declarations in accordance with GSA patent policy 103 upon approval of this application.

Applicant agrees to provide a minimum of 60-days notice prior to their renewal date should they elect to terminate membership.
Name: Date:
Title: Electronic Signature:

Application must be signed before it can be processed.

GSA membership decisions are, in large part, premised and reliant upon the accuracy of the information supplied by the applicant. By submitting this application, the applicant represents that the information contained herein is truthful and complete to the best of its knowledge.
 
Representatives Information 
PRIMARY REPRESENTATIVE
First Name: Zip:
Title: Country:
E-mail: Phone:
Address: Fax:
City: Cell:
State: Web site:
MARKETING REPRESENTATIVE
First Name: Zip:
Title: Country:
E-mail: Phone:
Address: Fax:
City: Cell:
State: Web site:
TECHNICAL REPRESENTATIVE
First Name: Zip:
Title: Country:
E-mail: Phone:
Address: Fax:
City: Cell:
State: Web site:
 
Payment Information 
A check payable to Gaming Standards Association is enclosed
Wire transfer (add 25$)
Charge fee to the credit card indicated below
 
Involvement / Participation 
Check all the committees that your company would like to participate
in or receive information about via e-mail:
Technical Committees:
System to System (S2S)
Game to System (G2S)
Gaming Device Standard (GDS)
Transport(TRA)
Internet Gaming Study (IGS)
Gaming Authentication Terminal(GAT)
Marketing Activities:

Events and Education

If you are interested in supporting one of the following
events, check here:

Trade Show Booth Sponsor
Trade Show Booth Volunteer
Meeting / Seminar Host
Session Moderator
Panel Participation
Comments / Suggestions: