OMG Membership Application Form

109 Highland Ave
Needham, MA 02494, U.S.A.

Ph:+1-781-444 0404
Fax: +1-781-444 0320
Email: [email protected]

OMG Membership Application

Company Information:

Corporate Information:

Organization Name: Name (if different):

Parent Organization
(if any): Street Address:

Primary Business: City:

Fiscal Year State or Province:

Web Location (URL): Postal Code:

Country:

Designated Representatives:

Please give the name of your Primary Representative who will be responsible for distributing OMG information within your organization, attending meetings, voting (if applicable) and serving as the communications channel.

Please provide the name of your Alternate Primary Representative who will also be responsible for distributing OMG information within your organization, attending meetings, voting (if applicable) and serving as the communications channel.

Salutation:	Mr. Mrs.Ms.Dr.
First Name:
Last Name:
Title:
Street :
City:
State:
Postal Code:
Country:
Email:
Phone:
Fax:

Salutation:	Mr.Mrs.Ms.Dr.
First Name:
Last Name:
Title:
Street :
City:
State:
Postal Code:
Country:
Email:
Phone:
Fax:

Please provide a different name of a Marketing Representative who will receive information about how your organization can participate in OMG's many marketing programs and events. Ideally this will be a member of your marketing department.

Please provide the name of your Alternate Marketing Representative who will also receive information about how your organization can participate in OMG's many marketing programs and events

Salutation:	Mr.Mrs.Ms.Dr.
First Name:
Last Name:
Title:
Street :
City:
State:
Postal Code:
Country:
Email:
Phone:
Fax:

Salutation:	Mr.Mrs.Ms.Dr.
First Name:
Last Name:
Title:
Street :
City:
State:
Postal Code:
Country:
Email:
Phone:
Fax:

Please provide a Billing contact person who can work with OMG's Finance department for membership fees, payment or other financial issues. (Please note, invoices are mailed to both billing and primary contacts.)

Please provide the name of a Public Relations Representative to whom the OMG can refer editorial opportunities.

Salutation:	Mr.Mrs.Ms.Dr.
First Name:
Last Name:
Title:
Street :
City:
State:
Postal Code:
Country:
Email:
Phone:
Fax:

Salutation:	Mr.Mrs.Ms.Dr.
First Name:
Last Name:
Title:
Street :
City:
State:
Postal Code:
Country:
Email:
Phone:
Fax:

Please provide a name different from the designated representatives to add as Senior Management contact person (CIO,VP of Engineering or Development, etc.) who can be available to discuss, with members of OMG upper management, important OMG business-related issues that may affect your organization.

(This information is strictly for OMG use only and will be kept confidential and private.)

Salutation: Mr.Mrs.Ms.Dr.

First Name:

Last Name:

Title:

Street :

City:

State:

Postal Code:

Country:

Email:

Phone:

Fax:

Membership Status:

The membership fee is based on two factors:

* For Contributing, Domain or Platform level, you MUST assign a Voter and Proxy to vote on technologies for adoption as industry standards. Thank you.

Voter:		Proxy Voter:

Contributing Members:
	US$500 million ( Annual Gross Revenue )	US$67,500	$7,500 saved of a regular price!
	US$100 - 499	US$33,750	$3,750 saved of a regular price!
	US$10 - 99	US$19,350	$2,150 saved of a regular price!
	US$0 - 9	US$9,900	$1,100 saved of a regular price!
Domain Members:
	US$500 million	US$33,750	$3,750 saved of a regular price!
	US$100 - 499	US$19,350	$2,150 saved of a regular price!
	US$10 - 99	US$9,900	$1,100 saved of a regular price!
	US$0 - 9	US$4,950	$550 saved of a regular price!
Platform Members:
	US$500 million	US$33,750	$3,750 saved of a regular price!
	US$100 - 499	US$19,350	$2,150 saved of a regular price!
	US$10 - 99	US$9,900	$1,100 saved of a regular price!
	US$0 - 9	US$4,950	$550 saved of a regular price!
Influencing Members:
	US$500 million	US$19,350	$2,150 saved of a regular price!
	US$100 - 499	US$9,900	$1,100 saved of a regular price!
	US$10 - 99	US$4,950	$550 saved of a regular price!
	US$0 - 9	US$2,700	$300 saved of a regular price!

Dues are yearly and payment is required upon signing and renewing membership!

How did you hear about us?

Information Kit from us

News Magazine

Trade Show

OMG Member Company

Please Specify:

Other

Please Specify:

Please let us know the name of an OMG employee or OMG international partner, if someone was instrumental in your decision to join OMG:

By clicking the 'Submit' button or printing and signing this document below, and mailing or faxing to OMG, the applicant acknowledges and agrees that, when received and accepted by the OMG, this application represents a binding contract between the parties and commits the applicant to (1.) payment of annual Membership dues and fees as determined from time to time by the Board of Directors (2.) comply with all the terms and conditions of OMG's Bylaws, each as from time to time amended, and such rules and policies as the Board of Directors and/or committees may from time to time adopt, (3.) comply with the OMG Trademark Usage Guidelines and user Requirements that may be amended from time to time, and (4.) the Terms and Conditions of OMG Membership. The applicant certifies that it has had the opportunity to review these documents to the extent it desired at the OMG website, that it meets the conditions of Membership specified in the Bylaws, and that it has accurately stated its revenues in calculating the fees payable with respect to the Membership class which it has selected above. All Membership dues are nonrefundable.

Method Of Payment:

Pre-payment is required to activate membership. Contact the OMG Membership Office, [email protected], for assistance, if necessary.

	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: 140 Kendrick Street, Building A, Suite 300, Needham, MA. 02494 U.S.A.
	Wire Transfer- Instructions will be sent to you via Email. Thank you! Object Management Group 109 Highland Ave Needham, MA 02494, U.S.A. Phone: +1-781-444 0404 Fax:+1-781-444-4864 Email: [email protected]

Please, Review All Information Prior To Completing This Transaction!
Please note: Payment is due at the time of registration! This form can not be "saved",
but you can print the filled form for your records.

Please type this code 3TMw8 into the field below, to complete the registration:

For more information, please contact The OMG Membership Office, [email protected], or Accounting Department
, Senior Vice-President of Finance, [email protected] , or call OMG at +1-781-444 0404 . With web/form related issues please contact [email protected].

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