Membership Application

Please select from the following options
Please accept this form as application for ACTI membership and invoice me for membership dues.
I have confirmed that my organization is an EDUCAUSE member or a unit within an EDUCAUSE member organization.
Please accept this form as application for ACTI membership - I will pay my dues now with a credit card.
I have confirmed that my organization is an EDUCAUSE member or a unit within an EDUCAUSE member organization.
Please contact me about ACTI membership.
Organization Information
Name of Organization:*
URL of Organization:
Main Representative (This individual will be your organization's primary contact regarding the ACTI community and its activities.)
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
 The Main Representative is also the Billing Contact
Billing Contact (receives communications regarding annual membership dues)
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.