PLEASE COMPLETE THIS FORM TO JOIN CISQ

    MEMBERSHIP LEVEL*:

    Large Industry - $25,000 (revenue ϯ >$50M/yr )
    Small Industry - $10,000 (revenue ϯ <$50M/yr )
    Not-for-profit, Academic, Government - $5,000

    ϯ If applicant is a subsidiary, membership level is based upon parent company revenue

    METHOD OF PAYMENT*:

    Credit Card (You will be able to continue with the payment on the next page.)
    Check

    • Make Checks Payable to: Object Management Group, Inc.

    • Mail to: 9C Medway Road, PMB 274, Milford, MA 01757 USA

    Wire Transfer (Instructions will be sent to you via Email.)

    ORGANIZATION GENERAL INFORMATION:











    PRIMARY REPRESENTATIVE FROM YOUR ORGANIZATION:

    (If the Address is the same as "Organization Info")










    ALTERNATE REPRESENTATIVE:

    (If the Address is the same as "Organization Info")










    MARKETING CONTACT:

    (If the Address is the same as "Organization Info")










    BILLING CONTACT INFORMATION:

    (If the Address is the same as "Organization Info")











    HOW DID YOU LEARN ABOUT CISQ?:

    SUBMIT YOUR LOGO

    Please attach your company's logo to be used on it-cisq.org web site.

    (high resolution PNG or EPS format. The min width should be 500px)

    Please review all information prior to submitting this form. Please print a copy of this form for your records.