Company Name: Phone:
Address (Street): Fax:
City: State/Province: ZIP/Postal Code:
Company Web Page Address:
Would you like a link to your Web Page on the WGNA Members list?
YES
NO
Type of Business:
Membership Level Requested:
Contact Information
Primary Contact Name: Phone:
Address (Street): Fax:
City: State/Province: ZIP/Postal Code:
E-mail Address:
Would you like this contact information to appear on the WGNA Members list?
YES
NO
Would you like this contact added to the WGNA Reflectors?
Technical Reflector: Yes No
Business Reflector: Yes No
Additional Contacts:
Marketing Contact
Name: Phone:
E-mail Address:
Would you like this contact listed on the WGNA Members list?
YES
NO
Would you like this contact added to the WGNA Reflectors?
Technical Reflector: Yes No
Business Reflector: Yes No
Public Relations Contact
Name: Phone:
E-mail Address:
Would you like this contact listed on the WGNA Members list?
YES
NO
Would you like this contact added to the WGNA Reflectors?
Technical Reflector: Yes No
Business Reflector: Yes No
Technical Contact
Name: Phone:
E-mail Address:
Would you like this contact listed on the WGNA Members list?
YES
NO
Would you like this contact added to the WGNA Reflectors?
Technical Reflector: Yes No
Business Reflector: Yes No
The above-named entity's application for participation and membership in the WideBand Gigabit Netowrking Alliance signifies acknowledgment and acceptance of the Policy Statement and Governing Rules of Conduct of the WideBand Gigabit Networking Alliance, and that Membership is contingent upon continued adherence to the most current published version of such rules.
Membership form completed and submitted by:
Title: Month: Day: Year:
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