IBWA Bottler Membership Dues Form

2020 IBWA Bottler Membership Dues Form

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BOTTLER MEMBERSHIP
IBWA Bottler members are companies that bottle or package water for sale within the United States (whether or not the plant is located in the United States) and that meet IBWA Bottled Water Code of Practice standards, which is verified by annual plant inspections.

IBWA has contracted with three companies to conduct annual inspections for Bottler member plants. This inspection is MANDATORY. You must select one of the inspection companies listed in Section IV of this form to conduct an audit for each plant you operate. The fees for inspection of your plant(s) are separate from your IBWA dues payment, but must be paid at time of application or membership renewal. See page 3, Section IV for additional information on the costs associated with plant inspections.

New Bottler members are assigned an initial status of Provisional Bottler until IBWA has received notification from the chosen inspection company that the facility or facilities have passed the plant inspection(s). Upon receipt of the notification, the new Provisional Bottler member will be assigned the status of IBWA Bottler member.

The TIER 2 inspection program is an addition to the current inspection program, and is open to any IBWA member Bottler who wishes to achieve certification under a Global Food Safety Initiative (GFSI) certification program. The fee for TIER 2 inspections are separate from your IBWA dues payment and are payable directly to the inspection vendor. See the enclosed inspection memorandum for additional information on TIER 2 inspection

Dues for Bottler members are based on gross bottled water sales and start at $6,460 for gross sales of $2,600,000 or less. See page 3, Section III for additional information. Total payment, including membership dues and plant inspection fee(s), for new members is due at the time of application.
Company Name
Address
Street Address City State / Province / Region ZIP / Postal Code Country
Website
Phone
Fax
Customer Number/Consumer Information
Facebook Account Name
Twitter Account Name
LinkedIn Account Name
Skype Account Name

COMPANY CONTACTS
Primary Representative
(Primary contact person to receive all communications from IBWA, including renewal notices and industry alerts)
Title
Direct Dial Number/Extension
Direct Fax
Email
Alternate Representative
(Additional company employee to receive communications from IBWA as part of the membership)
Title
Direct Dial Number/Extension
Direct Fax
Email
II. Company Information
Company information and information about gross sales are confidential and will be used by IBWA only in aggregate form with information from other IBWA members, when advocating for the bottled water industry with legislators and regulators
Number of Employees
Bulk water (tanker truck) seller?
- Yes
- No
Private label bottler?
- Yes
- No
Home and Office Delivery Provider?
- Yes
- No
III. BOTTLER DUES CALCULATION
Bottler dues are based on gross sales from the previous year. Total gross sales must include the following: a) Bottled water b) Distribution of other bottled water brands c) Sales and/or rental of coolers d) Cups
MY 2018 Gross Sales were:
Use the schedule below to calculate IBWA dues.

Total 2018 Gross Sales = Dues Payment/Formulas

$0 - $2,600,000 = $6,460 (U.S. Bottlers)
$2,600,001 - $10,000,000 = Total Gross Sales x 0.002500

$10,000,001 - $50,000,000 = Total Gross Sales x 0.002610

$50,000,001 - $100,000,000 = Total Gross Sales x 0.002718

$100,000,001 - $500,000,000= $271,827 + (0.0004152 x Total Gross Sales in excess of $100,000,000)

$500,000,001 - $1,000,000,000 = $437,908 + (0.0001053 x Total Gross Sales in excess of $500,000,000)

$1,000,000,001 and greater = $454,750 + (0.0001094 x Total Gross Sales in excess of $500,000,000)
Total IBWA Dues
Enter this figure in Section V Line A of this form

Amount to be charged
Card Number
Expiration Date
MM slash DD slash YYYY
Cardholder's Signature
Card Holder's Name
First Last
IBWA Sponsoring Member
(if referred by a current IBWA member)
SEND YOUR COMPLETED DUES FORM ALONG WITH PAYMENT TO THE IBWA MEMBERSHIP DEPARTMENT:
By mail:

IBWA 1700 Diagonal Road Suite 650 Alexandria, VA 22314

By fax:

703-683-4074

By email:

ibwainfo@bottledwater.org
For membership questions, contact the IBWA Membership Department at 703-647-4615 or cbass@bottledwater.org.
NOTE: MEMBERSHIP DUES ARE PAYABLE ON JANUARY 1 OF EACH YEAR
VI. IBWA POLITICAL ACTION COMMITTEE AUTHORIZATION TO SOLICIT
We have read the IBWA “Why a PAC?” flyer and are enclosing a signed IBWA PAC Authorization to Solicit form for our company. We understand that giving IBWA the Authorization to Solicit does not require any of our employees to make a contribution to the IBWA PAC.
“Become and IBWA PAC Program Sponsor! Your voluntary donation to IBWA will help fund PAC administration activities and allow every personal contribution to the IBWA PAC to go toward supporting the election or reelection of candidates who support the bottled water industry.”
VII. BRAND LIST UPDATE
The IBWA Member Brand List is a very popular item for consumers and the media who call IBWA’s hotline (1-800-Water-11) or visit the IBWA website. To ensure that the brand list is current and correct, list all of the proprietary/house brands your company produces, including brands that have added fluoride, as indicated on the label. Type or print clearly.
Company Brand
Container Size
Type of Container (PET, LDPE, Glass, Aseptic, etc.)
Company Brand
Container Size
Type of Container (PET, LDPE, Glass, Aseptic, etc.)
Company Brand
Container Size
Type of Container (PET, LDPE, Glass, Aseptic, etc.)
Company Brand
Container Size
Type of Container (PET, LDPE, Glass, Aseptic, etc.)
Company Brand
Container Size
Type of Container (PET, LDPE, Glass, Aseptic, etc.)
Company Brand
Container Size
Type of Container (PET, LDPE, Glass, Aseptic, etc.)
The IBWA Board of Directors approved a recommendation by the IBWA Bottled Water Quality Reporting Task Force to update the member brand listings on the IBWA web site to facilitate direct consumer access to water quality reports for specific brands, or to provide contact information that would inform consumers how such reports can be obtained.
To demonstrate their participation in this important program, Bottler members are asked to review the following statement and check the box if applicable:
I verify that 1) a bottled water quality report for each proprietary brand, that can be provided to consumers upon request, is available; and 2) a written company policy exists that includes information on how a bottled water quality report for each of our proprietary brands, will be provided if requested by consumers.

LOGO USE POLICY

MEMBER USE OF THE IBWA LOGO

The IBWA logo, the abbreviation "IBWA" and the inscription "International Bottled Water Association," is a mark owned by IBWA. The IBWA Board of Directors has issued instructions that the IBWA logo "CANNOT BE USED ON ANY LABEL OR ON ANY BOX CONTAINING PRODUCTS FROM OUR MEMBERS." Members may use the IBWA logo on their stationery, advertising, trucks, etc., but NOT on the product or its container/case. With respect to use of the abbreviation IBWA and/or the full inscription on product labels or containers, IBWA Bottler, Distributor and Supplier members are permitted to put the words "An IBWA Bottler (Distributor/Supplier) Member" or “IBWA Member” on the labels of their products. This must be in a straight line. It MUST NOT be bent or circled to imply a special logo, certification or guarantee.

For those Bottler, Distributor and Supplier members who wish to use "An IBWA" Bottler (Distributor/Supplier) Member" on their labels, WE DO REQUIRE that you agree to the following release: "I, for good and valuable consideration, including the license to use the International Bottled Water Association (IBWA) logo and inscription "An IBWA Bottler (Distributor or Supplier) Member," hereby release and agree to indemnify and hold harmless the IBWA from all claims, causes of action, liabilities or obligations of any kind, arising out of, connected with, or predicated upon membership in IBWA or the use of the said logo and inscription, it being thoroughly understood that the use of said symbol and inscription shall never be construed to create any warranty, expressed or implied, for or on behalf of IBWA in any manner whatsoever. Any goodwill derived from use of the mark inures exclusively to the benefit of IBWA. That said IBWA members agree to carry and maintain at their own expense, all necessary product liability insurance adequate to protect IBWA and any third party."

The use of "An IBWA Bottler (Distributor/Supplier) Member" or “IBWA Member” on your label is not required.

Members using the logo in the permitted applications must only print the logo in the official IBWA logo color (PMS #287), or in black, or in a “reverse,” where the background paper or other format shows through to form the logo. In no circumstances, can the IBWA logo in whole or in part be modified or duplicated within any company or brand logo.

Use of any mark that is confusingly similar to the IBWA mark is prohibited. Members further acknowledge that they are subject to all terms and conditions established by IBWA for use of its trademarks.
It is incumbent on each IBWA member to abide by this Board policy to ensure that all members enjoy the full benefits of using the mark. Please direct any questions concerning this policy to IBWA at 703-683-5213. I agree to comply with the IBWA logo policy.
Signature
Date
MM slash DD slash YYYY

If there are additional employees that you would like to receive IBWA News Splash, the Bottled Water Reporter magazine, and other announcements, please provide their contact information in the spaces available below. There is no limit to the number of additional contacts that can be provided to IBWA, so feel free to attach additional sheets of contact information, if needed. .

FAll additional contacts do not have to be located at the same address. For more Additional Contact sheets, go to: http://www.bottledwater.org/membership/dues-renewal, or make a copy of this page.
Additional Company Contacts
Name
First Last
Title
Phone
Fax
Email
Name
First Last
Title
Phone
Fax
Email
Name
First Last
Title
Phone
Fax
Email
Name
First Last
Title
Phone
Fax
Email
Name
First Last
Title
Phone
Fax
Email
Name
First Last
Title
Phone
Fax
Email
Name
First Last
Title
Phone
Fax
Email