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Text File  |  1997-07-28  |  3KB  |  117 lines
  1. Internet Society
  2. Organizational Membership Application
  3.  
  4. Please establish my organization as a member of the Internet
  5. Society. In addition to being a significant contribution to
  6. the evolution of the Internet and its use, membership 
  7. entitles my organization to representation on the Internet
  8. Society's Advisory Council, a subscription to OnTheInternet
  9. magazine, reduced rates for society conferences, and other
  10. benefits of special interest to organizational members.
  11.  
  12. __  Sustaining Gold Membershio
  13.     For-Profit Organization, $50,000 Annually
  14.  
  15. __  Sustaining Gold Membershio
  16.     Nonprofit Organization, $25,000 Annually
  17.  
  18. __  Executive Membership
  19.     For-Profit Organization, $10,000 Annually
  20.  
  21. __  Executive Membership
  22.     Nonprofit Organization, $5,000 Annually
  23.  
  24. __  Principal Membership
  25.     For-Profit Organization, $5,000 Annually
  26.  
  27. __  Principal Membership
  28.     Nonprofit Organization, $2,500 Annually
  29.  
  30. __  Professional Membership
  31.     For-Profit Organization, $2,500 Annually
  32.  
  33. __  Professional Membership
  34.     Nonprofit Organization, $1,250 Annually
  35.  
  36. __  Start-Up Membership
  37.     For-Profit or Nonprofit Organization During the 
  38.     First Three Years of Operation--$1,000 Annually
  39.  
  40.  
  41. Contact Person
  42. Organization/Institution
  43. Postal Address
  44.  
  45. E-mail Address
  46. Telephone
  47. Fax
  48.  
  49. Billing Address (if different from above)
  50.  
  51.  
  52. As the contact person, please check the box that best
  53. describes your position:
  54.  
  55. __  Owner/President/CEO/CIO
  56. __  Director/Manager
  57. __  Product Development Manager
  58. __  Systems Manager/Administrator
  59. __  Network Manager/Administrator
  60. __  Marketing/Advertising Manager
  61. __  Engineer
  62. __  Programmer
  63. __  Professor/Associate Professor
  64. __  Researcher/Assistant
  65. __  Librarian
  66. __  Consultant/Self-Employed
  67. __  Student
  68. __  Other
  69.  
  70. Please check the box that best describes your organization:
  71.  
  72. __  Network Service 
  73. __  Software Company
  74. __  Information/Systems Management 
  75. __  Product Provider
  76. __  Educational Institution
  77. __  Nonprofit Organization
  78. __  Public or Private Library
  79. __  Publisher
  80. __  Other
  81.  
  82.  
  83. Payment may be made by check, credit card,  money order, or wire transfer.
  84. U.S. currency only.
  85.  
  86. __  Payment is enclosed.
  87. __  Please bill my organization.
  88.  
  89. Credit Card information:
  90.  
  91.    __  American Express
  92.    __  Mastercard
  93.    __  Visa
  94.  
  95.    Credit Card Number:  __________________________________
  96.    Name on card:        __________________________________
  97.    Expiration Date:     ___________
  98.  
  99. Send wire transfers to:
  100.  
  101. Internet Society Acct. No.148 38 710
  102. ABA No. 054000030
  103. Riggs National Bank of Virginia
  104. 950 Herndon Parkway
  105. Herndon, VA  20171
  106.  
  107. Send checks and money orders to:
  108.  
  109. Internet Society
  110. 12020 Sunrise Valley Drive, Suite 210
  111. Reston, VA 20191-3429
  112. U.S.A.
  113.  
  114. Phone: 800-468-9507 (U.S.A. only) or +1 703-648-9888
  115. Fax: +1 703-648-9887
  116. org-membership@isoc.org * http://www.isoc.org
  117.