Corporate Patron Membership Form

 

Join the Association for Information Science & Technology today!

Fill in the following membership application, join today, and begin taking advantage of member discounts, publications, special interest groups, and more! If you wish to pay by credit card, fill in this form and submit securely online.  If you are paying by check, please print out a copy of this form, fill it out, and send it in along with your payment.

Official Organizational Representative:

This person serves as the organization's primary contact and liaison to ASIS&T. The Organizational Representative receives the FREE individual membership included with this membership and enjoys all the same benefits as Regular Members.

Ms. Mr.       **required fields
  **First Name:
  **Last Name:  
Title:
  **Company Name:  
Department or Division:
  **Mailing Address:  
  **City:  
  **State/Province:  
  **ZIP/Postal Code:  
Country:
  **Phone:  
FAX:
  **E-Mail:  

Billing Address:

(if different from that of Organizational Representative)
Ms. Mr.
First Name:
Last Name:
Title:
Department or Division:
Mailing Address:
City:
State/Province:
ZIP/Postal Code:
Country:
Phone:
FAX:
E-Mail:

Address Where you Want your Subscriptions Sent:

(if different from that of Organizational Representative)
Ms. Mr.
First Name:
Last Name:
Title:
Department or Division:
Mailing Address:
City:
State/Province:
ZIP/Postal Code:
Country:
Phone:
FAX:
E-Mail:

Payment Information

Membership: Corporate Patron
You can join for 1 year or up to 5 years at today's rates!
Years:   1   2   3   4   5
Payment:

Credit Card Number:
Expiration Date:
Company Purchase Order #:
                                  

If you are paying by check, please make your check payable to ASIS&T. Send checks to the following address:

ASIS&T
8555 16th Street
Suite 850
Silver Spring, MD 20910

Phone: (301) 495-0900 Fax: (301) 495-0810
e-mail: membership@asis.org