Membership Application

Please select from the following options
Please send me an EDUCAUSE membership packet
Please contact me regarding EDUCAUSE membership
Please accept this form as application for membership and invoice me for EDUCAUSE membership dues
Please accept this form as application for membership - I will pay my dues now with a credit card
Organization Information
Name of Organization:*
URL of Organization:
Primary Contact Information
Full Name:*
(ex. "John Doe, Jr.")
Nickname:
Job Title:*
Organization:*
Address:*
City/State/Zip-Postal Code:*    
Country:
Phone:*
E-mail:*
Personal URL:
RSS URL:
* Required fields
Additional Comments
 

Information submitted on this form is subject to verification by EDUCAUSE staff.