National Warheads and Energetics Consortium (NWEC)
Membership Application

This Membership Application is made by the signing organization ("Applicant") to the National Warheads and Energetics Consortium ("NWEC") Executive Director as of the date of signing by the Applicant. Note: The NWEC Executive Director and his/her phone numbers are listed at the end of this Application.

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1. Applicant hereby applies for membership in the NWEC. Applicant agrees that it will review and sign the Consortium Member Agreement and review the Ordnance Technology Base Agreement. Applicant does not become a NWEC member until Applicant reviews and signs these Agreements.

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2. Applicant, by signing this Application, represents that the information herein is a complete, true and correct statement of Applicant's organization. Applicant agrees to disclose immediately to the NWEC Executive Director any changes affecting Applicant's representation that it meets the requirements of membership.

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3. Applicant agrees that the NWEC Executive Committee has the right to accept or reject Applicant in its sole discretion if such Committee determines that Applicant does or does not meet the membership requirements contained in this Application, the Other Transactions Base Agreement and the Consortium Member Agreement. The Committee will notify Applicant within a reasonable time of Applicant's membership status, and if Applicant is rejected for membership, the reason for the rejection.

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4. Is applicant a United States owned Company?
Yes or No required

If Yes, Answer question 4A below. If No, applicant must attach a letter from the Defense Security Service verifying that it has an approved plan or special security agreement for negating or mitigating the risk of foreign ownership, control or influence. In this case, membership can only be granted with concurrence of the DOTC Program Office.

4.A. Is applicant operating under Foreign Influence, Ownership or Control (FOCI)?
Yes or No required

If Yes, applicant must attach a letter from the Defense Security Service verifying that it has an approved plan or special security agreement for negating or mitigating the risk of foreign ownership, control or influence. A U.S. company is considered under FOCI whenever a foreign interest has the power, direct or indirect, whether or not exercised, and whether or not exercisable through the ownership of the U.S. company's securities, by contractual arrangements or other means, to direct or decide matters affecting the management or operations of that company in a manner which may result in unauthorized access to [export controlled information,] classified information or may adversely affect the performance of classified contracts. National Industrial Security Program Manual (DoD 5220.22-M, Para. 2-300a.).

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5. Applicant agrees to provide proof of the required facility and personnel clearance prior to award of any classified project activity.

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6. Applicant represents that it is eligible to contract with the United States Government, i.e., Applicant is not debarred or suspended by the United States Government

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7. Applicant represents the following:

1. It has an interest in the research and development of warheads and energetics technology,
2. It is capable of making a technical contribution to the advancement of warheads and energetics technology,
   
3. It is willing to be an advocate of the NWEC objectives as they are defined in the Other Transactions Agreement and the Consortium Member Agreement.

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8. Applicant agrees that it will participate in semi-annual NWEC meetings of the General Membership, those committees and/or subcommittees to which it may be nominated and elected to serve on, and those committees and/or subcommittees to which it will voluntarily provide representation as indicated herein.

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9. Applicant understands that as a member of NWEC, it may be necessary for Applicant to make some resource contribution (i.e., cash, in-kind, etc.) if Applicant determines such contribution serves the best interests of Applicant and the Government.

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10. Applicant's legal corporate/organization name: required

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11. Applicant DUNS Number: required

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12. Applicant CAGE Code: required

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13. Applicant Joint Certification Program Certification No. (DD2345): required

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14. Address of Applicant's principal offices:

Street Address 1:
required

Street Address 2:

City:
required

State:   Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming required

Zip: required

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15. Applicant's designated contact information (and address if different from above):

Name:
required

Street Address 1:

Street Address 2:

City:

State:   Select a State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Zip:

Work Phone:
required

Work Fax:
required

Work Email:
required

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16. Are you currently a "Non-traditional Defense Contractor" (A business unit that has not, for a period of at least one year prior to the date of application, entered into or performed on: (1) any procurement contract that is subject to full coverage under the cost accounting standards or (2) any FAR based procurement contract in excess of $500,000)? (For additional information, please contact the Consortium Management Firm)

Yes or No required

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17. Applicant is a: required

Parent Corporation
Academic Institution
Minority Owned Business
Subsidiary
Not-For-Profit
Small Business
Division
Non-Profit
Woman Owned Business

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18. Provide below a brief description of the nature of Applicant's business as it may apply to research and development in the field of warheads and energetics technology:
required

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19. Describe below Applicant's current research and development plans and capabilities that may be applicable to warheads and energetics technology:
required

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20. Check those Committees and/or Subcommittees upon which Applicant will serve if nominated and elected:

Executive Committee
Technology Committee
Business Development Committee

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21. Check those Subcommittees upon which Applicant will voluntarily provide representation:

Explosives Subcommittee
Enabling Technologies Subcommittee
Insensitive Munitions Subcommittee
Propellants Subcommittee
Pyrotechnics Subcommittee
Warheads Subcommittee
Fuzing/Sensors Subcommittee
Demilitarization Subcommittee
Protection & Survivability Subcommittee

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Select the "Process this membership application for review and printing" button to review, print and complete Section 20.

22. Applicant acknowledges that it has read and understands the application form, the Other Transaction Base Agreement, and the Consortium Member Agreement, to which the applicant agrees to meet its obligation, in its entirety, and is undertaking and has caused this Application to be signed by its duly authorized representative on the date set forth below:

Applicant Name	____________________________________
By	____________________________________
Title	____________________________________
Date	____________________________________