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                                                           24 Feb 1994

               Application for Organization Membership

        (For-profit Corporations and Non-profit Organizations
        such as Foundations, Educational Institutions, Trade
        and Professional Organizations, Government Agencies,
                and other International Organizations
                                  
/_/ Please  establish  my  organization  as a member  of  the  Internet
    Society.   In  addition  to  contributing  significantly   to   the
    evolution  of  the  Internet and its use, membership  entitles  the
    organization  to representation on the Society's Advisory  Council,
    receipt  of the quarterly Internet Society News, reduced  fees  for
    attendance  at Internet Society conferences and other  benefits  of
    special  interest  to  organizational  members.   Membership   will
    extend for 12 months from the month of application receipt.

    /_/  Regular membership, for-profit organization at $10,000 annually

    /_/  Regular membership, non-profit organizations at $5,000 annually


    /_/  Associate membership, for-profit organization at $5,000 annually

    /_/  Associate membership, non-profit organization at $2,500 annually


    /_/  Contributor membership, for-profit organization  at $2,500 annually

    /_/  Contributor membership, non-profit organization  at $1,250 annually


    /_/  Start-up membership, for-profit or non-profit organization during the 
         first three years of operation at $1,000 annually....Startup year : 19 ___

/_/ Please send me additional information on the Internet Society


  Organization: 

  Person Primary Responsible:

  Postal Address:

  
  
  Internet Email address:

  Fax:                      Telephone:


Payment Information:

 Payment of annual dues may be made by check, money order, or wire transfer.

 /_/ Payment is included with this application

 /_/  Please bill my organization


Send wire transfers to:
 Riggs Bank of Virginia     Bank ABA number: 056001260
 8315 Lee Highway           Account number: Internet Society 148 187 10
 Fairfax  VA  22031
 USA


Please send by fax, email, or post to:

 Fax: +1 703 620 0913 (until 16 Mar)
 Fax: +1 703 648 9887 (after 16 Mar)

 Email: <org-membership@isoc.org>

 (until 12 March 94)    (after 12 March 94)

 Internet Society       Internet Society
 1895 Preston White Dr  12020 Sunrise Valley Dr, suite 270
 Reston  VA  22091      Reston  VA  22091
 USA                    USA

                                                    Form 94-002 v.1.2
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