======================================================================== 1 May 1994 Application for Organizational Membership (For-profit Corporations and Non-profit Organizations such as Foundations, Educational Institutions, Trade and Professional Organizations, Government Agencies, and other International Organizations /_/ 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 application receipt. /_/ Regular membership, for-profit organization at $10,000 annually /_/ Regular membership, non-profit organizations at $5,000 annually /_/ Associate membership, for-profit organization at $5,000 annually /_/ Associate membership, non-profit organization at $2,500 annually /_/ Contributor membership, for-profit organization at $2,500 annually /_/ Contributor 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 : 19 ___ /_/ Please send me additional information on the Internet Society Organization: Person Primary Responsible: Postal Address: Internet Email address: Fax: Telephone: Payment Information: Payment of annual dues may be made by check, money order, or wire transfer. /_/ Payment is included with this application /_/ Please bill my organization Send wire transfers to: Riggs Bank of Virginia Bank ABA number: 056001260 8315 Lee Highway Account number: Internet Society 148 187 10 Fairfax VA 22031 USA Please telephone or send by fax, email, or post to: Fax: +1 703 648 9887 Tel: +1 703 648 9888 Tel: 800 468 9507 (USA only) Email: Internet Society 12020 Sunrise Valley Dr, suite 270 Reston VA 22091 USA Form 94-002 v.1.6 ========================================================================