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IMTC Membership Registration Form


* 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
	Individual Participant No Dues
	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.