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    PartnerNetwork Member Application

    Is organization based in the Unites States?

    Registration Type
    (See Member Dues & Size Standards)

    Member Point of Contact

    Member Name and Primary Location

    Organization Name

    Primary Address

    Website

     

    Set-aside Qualifications

    SAM.gov Unique Entity ID, if registered:

    Qualifying Exemptions (select one or more as applicable)

    Is your company considered Traditional or Non-Traditional?

    A non-traditional defense contractor is an entity that is not currently performing and has not performed in the past 12 months on contracts or subcontracts with a combined valued of $50 million or more for the Department of Defense.

    Size and Compliance

    Organization Annual Revenues

    Number of Employees

    Sensitive Data Compliance (select one or more as applicable)

    FCL Clearance (Facility Security Clearance Level)

     

    Offerings and Areas of Interest

    Organization Offerings

    Technology Areas of Interest
    (Hold the CONTROL KEY to select multiple options)

    Are you interested in government-funded Technical and Business Assistance (TABA)?

    Applicant Acknowledgement

    __ Applicant is eligible to contract with the U.S. Government (i.e., not debarred or suspended by the United States Government);
    __ Applicant is interested in collaborations aimed at supporting government modernization initiatives, rapid acquisition strategies, and warfighter innovation efforts;
    __ Applicant is capable of making contributions to at least one Capability Focus Area; and
    __ Applicant acknowledges having read, understood, and accepted this Patriot Labs PartnerNetwork Application and the Code of Conduct.

    Patriot Labs has the right to accept or reject any PartnerNetwork applicant at its sole discretion. No member dues will be incurred if rejected for membership.

    Date:

    Application#
    45872020925926