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Calendar Year Member Dues

Active Members are voting members that are required to hold committee or board seats.

Associate Members are voting members who can hold seats but are not required to.

Affiliate Members are non-voting and join to support our cause. Affiliate members pay $149 per year.

Please choose one of the following membership options.

Active Membership
$250 (or $75 per quarter) - Gross revenue under $750K
$495 (or $150 per quarter) - Gross revenue over $750M
Assoicate Membership
$350 (or $100 per quarter) - Gross revenue under $750K
$599 (or $175 per quarter) - Gross revenue over $750K
Affiliate Membership
$149 
We would like to be billed:
Quarterly
Annually

Membership Application
Services Your Company Provides:
Dial Up Service T1/DS1
DSL Service - Sprint T3/DS3
DSL Service - BellSouth OC3 or higher
DSL Service - Verizon Wireless Services
DSL Service - SBC VoIP Services
DSL Service - Other Hosting
Other
Contact Information
Company Name  
Company Type     
Street Address     
City State Zip        
Phone Number    
Contact Name & Title   
Email Address     
Alt Contact Name/Title  
Email Address     
Company URL     
How did you hear about IIA?     

Payment Method: Paypal Credit Card Invoice

Send Paypal payments to: isps@ii4a.org  Members wishing to use credit card will be contacted for card information.

Name of Person Completing This Form     

   
Independent ISPs For America, Inc. ¤ 4218 Autumn Leaves Drive ¤ Tampa FL 33624
ISPs@II4A.org ¤ 813-496-2122 fax 530.323.7025