Organisation Members 

I am applying for:

Gold membership, for-profit organisation at $50,000 annually
Gold membership, non-profit organisation at $25,000 annually
Silver membership, for-profit organisation at $25,000 annually
Silver membership, non-profit organisation at $12,500 annually
Executive membership, for-profit organisation at $10,000 annually
Executive membership, non-profit organisations at $5,000 annually
Professional membership, for-profit organisation at $5,000 annually
Professional membership, non-profit organisation at $2,500 annually
Small business membership, for-profit organisation at $2,500 annually
Small business membership, non-profit organisation at $1,250 annually
Please send me additional information on the Internet Society

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 (in US $):

50,000 25,000 12,500 10,000 5,000 2,500 1,250

How would you like to pay?

1. Bank Transfer. Please contact us for bank account information at ap@Isoc.org
2. Check or Money Order

   If your organisation is in the Americas, Asia, or the Pacific, please mail to:

   Internet Society

   1775 Wiehle Ave., Suite 201

   Reston VA 20190

   USA

   If your organisation is in Europe, the Middle East, or Africa, please mail to:

   Internet Society

   Galerie Jean-Malbuisson 15

   CH-1204 Geneva

   Switzerland

3. Bill me at my address given above.
4. Credit card:
   Mastercard.
   Visa.
   American Express.

   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

Click the "Send Application" button to complete your application:

Click the "Erase Application" button to cancel your application: