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Membership Application

Please select from the following options
Please accept this form as application for membership and invoice me for Net@EDU 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
Select the Working Group(s) you are interested in:
Broadband Policy Group
Integrated Communications Strategies
Identity Management
State Education Networks
Wireless Campus Networking
Additional Comments
 

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