# - Internet Society

Application for Organizational Membership


This form allows you simply and easily to apply for Internet Society membership. Please note that this page only works if your browser supports forms.

If you cannot or do not want to use this form, you may alternatively obtain an application template which you can complete and send yourself by fax (+1 703 648 9887) or email (org-membership@isoc.org).

Please establish my organization as a member of the Internet Society. In addition to contributing significantly to the evolution of the Internet and its use, membership entitles the organization to representation on the Society's Advisory Council, receipt of the quarterly Internet Society News, reduced fees for attendance at Internet Society conferences and other benefits of special interest to organizational members. Membership will extend for 12 months from the month of receipt of payment.


I am applying for:
Executive membership, for-profit organization at $10,000 annually
Executive membership, non-profit organizations at $5,000 annually

Principal membership, for-profit organization at $5,000 annually
Principal membership, non-profit organization at $2,500 annually

Professional membership, for-profit organization at $2,500 annually
Professional membership, non-profit organization at $1,250 annually

Start-up membership, for-profit or non-profit organization during the first three years of operation at $1,000 annually. Startup year:

Please send me additional information on the Internet Society
What is your organization:

Person primarily responsible:

Family Name:

Given Name(s) :

What is your title:

What is your address:

City: State or Province: Postal Code:

Country:

EMail address:

Fax Number:

Telephone Number:


Payment

All payments must be in United States dollars. Payment of annual dues may be made by check, money order, credit card or wire transfer.

Please indicate the payment you wish to make:

US$

How would you like to pay?

  1. Bank Transfer
    Send to bank:
    Account number: Internet Society 14 838 710
    Bank ABA number: 054000030
    Riggs National Bank of Virginia
    950 Herndon Parkway
    Herndon VA 20171
    USA

  2. Check or Money Order
    Please mail to:
    Internet Society
    12020 Sunrise Valley Dr #210
    Reston VA 20191-3429
    USA

  3. Bill be at my address given above.
  4. Credit card:
    • Mastercard.
    • Visa.
    • American Express.
    • Carte Blanche.

      Credit Card Number:

      Expiration Date:

      Name on Card:

      Do we have your authorization to charge the indicated total against your card number? (Type YES)


To submit your application and pay as indicated

Push the following to automatically email to (org-membership@isoc.org) :

If you want to terminate this session, push the following:

Thank you.


orgmem@isoc.org