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ControlNet International

Membership Fax-Back Application
FAX: (1) 734-922-0027

Membership in CONTROLNET INTERNATIONAL LTD. is available to organizations which currently (or have plans to) design, manufacture, distribute or use hardware or software products that are compatible with ControlNet. Applications are subject to review and approval by the CONTROLNET INTERNATIONAL Board of Directors in accordance with CONTROLNET INTERNATIONAL rules and procedures as may be in effect from time-to-time.
(DOC00055)
Applicant Information

Name of Organization:

Jurisdiction of Incorporation
(State or Country):

Address of Principal Office:

City/State/Zip/Country:

Telephone:

Facsimile:

Designated
Representative Name:

Street Address:

City/State/Zip/Country:

Telephone:

Facsimile:

e-mail:

Name of Parent
Organization:

Jurisdiction of Incorporation
of Parent Organization
(State or Country):

Address of Principal
Office of Parent:

City/State/Zip/Country:

Type of Membership . . . (check one)

Membership Classification	Annual Dues	1st Year Discount for ODVA Members
Founding (3-year membership)	$100,000 USD-1yr
	$30,000 USD-2yr
	$30,000 USD-3yr
Regular (1-year membership)
>100 Employees	5,000 USD	25%
<100 Employees	1,000 USD	25%
Associate (non-voting, 1-year membership)	1,000 USD	N/A

Dues are non-refundable, and membership is conditioned on payment of dues in full.

By having an authorized representative sign below, Applicant agrees and represents that he/she has read the reverse side of this application, agrees with the terms of membership and, for Regular Member Applicants, affirms that the number of employees represented above is accurate.

Authorized Signature:	Date:
Printed Name:	Title:

2370 East Stadium Boulevard * #1005
Ann Arbor, Michigan 48104-4811 USA
Phone: (1) 734-922-0025 * Fax: (1) 734-922-0027
e-mail: controlnet@controlnet.org

ControlNet is a trademark of ControlNet International, Ltd.