NOTE: REQUIRED FIELDS ARE MARKED WITH * MEMBERSHIP LEVEL*: (select the level matching your company's annual gross revenue) Start-up (Pre-Revenue) - $1,000 University/Non Profit - $2,500 Government - $7,500 Small ($0-5M revenue) - $5,000 Medium ($5-50M revenue) - $10,000 Large ($50M-200M revenue) - $25,000 Extra Large ($200M+ revenue) - $50,000 Contributing Member - $150,000 ϯ If applicant is a subsidiary, membership level is based upon parent company revenue ORGANIZATION GENERAL INFORMATION: Select Industry below*:AgricultureAcademia & ResearchBuildingBusiness ServicesConsumer & HomeAerospace & DefenseEnergyFinance & BankingHealthcareIndustry AssociationIT & NetworksManufacturingPublic SectorPublic Security & Public SafetyRetailTransportation PRIMARY REPRESENTATIVE FROM YOUR ORGANIZATION: (If the Address is the same as "Organization Info") Salutation:*Ms.Mrs.Mr.Dr.Prof. BILLING CONTACT INFORMATION: (Click-if the Address is the same as "Organization Info") Salutation:*Ms.Mrs.Mr.Dr.Prof. 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.) Contact the DTC by e-mail HERE, or by calling +1-781-444-0404. The DTC is headquartered in Boston MA, USA. PLEASE REVIEW ALL INFORMATION PRIOR TO SUBMITTING THIS FORM. PLEASE PRINT A COPY OF THIS FORM FOR YOUR RECORDS.