Please fill out this application form as completely as possible. You will have a choice of payment options including check/money order, electronic funds transfer, credit card, or Paypal. Part 1. Member Information Please enter the name of your company or organization as you wish it to appear on the Consortium's member roster. Provide the business address of your Primary Representative. Provide the URL which you wish to appear on the Consortium's member roster. (We would appreciate being able to put your organization's logo on our membership page and will ask your permission when we contact you after receiving your membership application.) Member Name * Address 1 Address 2 City State or Province Postal Code Country URL Part 2. Contact Information Primary Representative Name * Email Address * Telephone * Fax Alternate Contact Optional; does not apply to Individual Membership. For Emergent Vendor members, who are limited to one active representative, the Alternate Contact may request a userid on the CalConnect system as a way of keeping current, but may not actively participate in Technical Committee activities or attend CalConnect events. Name Email Address Telephone Fax Administrative/Invoice Contact If not specified, the Primary Contact will be sent membership invoices and any related correspondence. Name Email Address Telephone Fax Address 1 Address 2 City State or Province Postal Code Country Part 3. Membership Type and Fees Please select your membership type and associated fee: $10,000 - Commercial Vendor, > $100M Revenue $7,500 - Commercial Vendor, $10M-$100M Revenue $5,000 - Commercial Vendor, $5M-$10M Revenue $3,000 - Organizational Member $1,000 - Small Organizational Member (minimal staff and revenue) $500 - Individual[1] Member Type * 1An individual member may only represent his or her interests or views, and may not participate or act on the behalf of any other person or organization, regardless of his or her affiliation or employment status PLEASE NOTE: All new members regardless of category will be invoiced for 50% of your regular membership fee for your first year of membership. You will also receive a 50% discount on event fees during your first membership year. Part 4. How do you wish to pay? You will receive an invoice for your membership as soon as we have processed your membership application. We will pay by check or money order (must be issued by a U.S. bank) We will pay by ACH (electronic funds transfer) (please contact us for transfer details) We will pay by credit card (Visa, Mastercard, American Express) (please contact us to arrange) We will pay via Paypal (send your payment to: calconnect@calconnect.org) Payment Type * If you have a Purchase Order and wish your Purchase Order Number shown on your invoice please enter it here: Purchase Order Your membership will become effective upon receipt and processing of your membership application and issuance of an Invoice for Payment. Your membership renewal will be due each year before or on your anniversary date, the date on which your membership became effective. The Consortium will invoice you for your membership renewal approximately 60 days prior to your anniversary date; you may request more advance notice if you wish. Part 5. Membership Agreement By completing this Membership Application and paying the appropriate membership fee, your organization agrees to the Consortium Membership Agreement. Membership Agreement * We have reviewed and will comply with the Consortium Membership Agreement. Part 6. Optional Questions Please take a moment to briefly answer these questions about your organization. Your responses will aid us in helping you to become familiar with CalConnect and become active in areas that interest you. What is your organization's business, products, or purpose? What are your particular interests in CalConnect? Would you be willing to do a short presentation at the next CalConnect Conference about your organization and what it does? (If not the next one, the next one you plan to attend.) Part 7. Membership Application Form Submission Please review your completed membership application form carefully. You may use the "CLEAR" button below to clear the entire form and re-enter all information. Once you have pressed the "SEND" button below, you will be given further instructions for completing the financial transaction according to the type of payment you have requested. Leave this field blank What code is in the image? * Send
