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Membership Application Form

Company Information (Information for Corporate Headquarters):

Company Name: Phone:
Address (Street): Fax:
City: State: Zip/Postal Code:
Company Web Page Address:
Type of Business:
Membership Level Requested (Check one):

        _____ Steering Committee Member ($2,500 US per quarter)

        _____ Contributing Member ($1,000 US per quarter)

        _____ Member ($250 US per quarter)

        _____ Associate Member ($100 US per quarter)

        _____ Academic Member (No fee)

        _____ Press Member (No fee)


Contact Information:

Primary Contact Name: Title:
Address (Street): Phone:
City: State: Zip/Postal Code:
E-mail: Fax:
Please list this contact on the WGNA Members List    ___Yes   _____No
Please add this contact to the WGNA Technical Reflector   ___Yes   _____No
Please add this contact to the WGNA Business Reflector   ___Yes   _____No


Additional Contacts:

Marketing Contact Name:
E-mail: Phone: Fax:
Please list this contact on the WGNA Members List    ___Yes   _____No
Please add this contact to the WGNA Technical Reflector   ___Yes   _____No
Please add this contact to the WGNA Business Reflector   ___Yes   _____No
Public Relations Contact Name:
E-mail: Phone: Fax:
Please list this contact on the WGNA Members List    ___Yes   _____No
Please add this contact to the WGNA Technical Reflector   ___Yes   _____No
Please add this contact to the WGNA Business Reflector   ___Yes   _____No
Technical Contact Name:
E-mail: Phone: Fax:
Please list this contact on the WGNA Members List    ___Yes   _____No
Please add this contact to the WGNA Technical Reflector   ___Yes   _____No
Please add this contact to the WGNA Business Reflector   ___Yes   _____No


The above-named entity's application for participation and membership in the WideBand Gigabit Networking Alliance significes 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:
Signature: Title:
Please print name: Date:
WGNA 26900 East Pink Hill Road, Independence, MO 64057
(816) 229-3800       FAX (816) 229-1000
Copyright © 1997 WGNA
pcherry@wgna.org