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IMTC Membership Registration Form


If you are applying for Individual Participant do not complete this page. Please complete an Individual Participant FORM and fax to the IMTC office at 925.275.6691. If you have any questions, email . * Required Fields
Organization Information (Not required for Individual Participant.)
Name of Organization:	*
Web Site Address:	*
Primary Contact Information (Primary contact is the person who can vote and handle correspondence on behalf of the organization.)
First Name:	*
Last Name:	*
Title/Job Function:	*
Street Address:	*
City:	*
State/Province:	*
Country:	*
Zip/Post Code:	*
E-Mail Address:	*
Phone Number:	*
Fax Number:
Secondary Contact Information (Secondary contact is the person who can act in the primary contact’s absence. Not required for Individual Participant.)
First Name:	*
Last Name:	*
Title/Job Function:	*
Street Address:	*
City:	*
State/Province:	*
Country:	*
Zip/Post Code:	*
E-Mail Address:	*
Phone Number:	*
Fax Number:

Membership Level Before applying, please review the details on the benefits and rights of each membership level.
	IMTC Full Voting Membership US $8,500 (does not include use of IOTzilla fees)
	IMTC Associate Membership US $4,000
	Non Profit/University Membership US $1,000
	I am forwarding a check for the amount due
	I intend to wire transfer the amount due, and understand I should add US $15 to the amount due for this purpose.
	I am providing a Purchase Order Number (Please invoice me)
Comments:

Intent to Join the IMTC, Inc. By completing this form, my organization is declaring its intent to join IMTC, Inc. and committing to pay dues for the first twelve months. I understand that my organization will be listed as a Member when Membership Dues are received by IMTC. (Not required for Individual Participant.)
Authorized Individual Name	*
Title	*
Date	*

Humanness Please enter the words you see in the box, in order and separated by a space. Doing so helps prevent automated programs from abusing this registration process.

To join the IMTC, complete this form and mail a check or Purchase Order for the appropriate amount to:

IMTC, Inc.
Bishop Ranch 6
2400 Camino Ramon, Suite 375
San Ramon, CA 94583, USA.
Attention: IMTC Secretary
Phone: +1.925.275.6600
Fax: +1.925.275.6691

You will receive an acknowledgment within two weeks.
Thank you for your membership.