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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.
