Membership Application Form

Internet of Things International Forum (IoT FORUM)

The Internet of Things International Forum (IoT Forum) is open to all interested parties. To become a member of the forum, please complete this form carefully. The completed and signed form should be sent to the secretariat of the IoT Forum. The applicant will become a Member on acceptance of the application by the IoT Forum General Assembly and completed payment.

The annual membership fee is payable as per the calendar year. For Ordinary Members, it is 1000 Euro and for Sponsor Members, 5000 Euro.

For Membership rights, entitlements, and benefits, please request the IoT Forum Articles of Association from the secretariat of the IoT Forum.

Name of Applicant – Individual or Organisation

[fill in name of (person for individual membership) or (organisation)]

Please specify what kind of IoT Forum membership is intended.

Ordinary Member (1000 Eur)

Sponsor Member (5000 Eur)

Calendar year of membership applied for:

[fill in year e.g. 2015]

Release of name/logo:

Upon becoming a Member of the IoT Forum, the Applicant (Individual or Organisation) agrees that the IoT Forum may, in connection with the membership, and so long as the Applicant is a Member, publish the applicant's name, the Membership status and the date on which the Applicant became a Member. If the applicant is an organisation, the logo (to be submitted with this application as a good quality digital image) will also be published on the website and will also be used in promotional material of the IoT Forum.

Declaration:

I, / [fill in name of person]

as a qualified individual or an authorised person of the Applicant Organisation mentioned above, hereby apply for membership of the Internet of Things International Forum (IoT Forum), and further declare that the Applicant :

-Agrees to respect all legal provisions and statutes concerning the IoT Forum as described in the Articles of Association, signed version, dated June 19th 2013 (available on the IoT Forum website)

-or its representative(s) named overleaf shall be the official contact person(s) for receiving formal notices, voting papers, and invoices,

-shall become a member of the IoT Forum upon payment of membership fees after the acceptance of this application by the General Assembly.

Please send the application form to the IoT Forum Secretariat (details are available on page 4). An invoice for the annual membership fee will be sent to you after approval of the membership application.

Signature: / Company stamp:
Name in Full:
Position:
Date / Place:

Designated Representative (Voting Contact):

Please fill in all the fields below.

Personal Name
Family Name
Organisation
Title
Address
City
State
Country
Postal Code or ZIP
Telephone
Fax
E-mail

Billing Contact (To be filled in if different from the Designated Representative)

Please fill in all the fields below.

Personal Name
Family Name
Organisation
Title
Address
City
State
Country
Postal Code or ZIP
Telephone
Fax
E-mail
Description of Applicant (Individual or Organisation):
Reasons for the Applicant to apply for IoT Forum membership:
Logo (for organisations):
Please also indicate a link for downloading the logo or send the logo via email to the secretary.
Website address to appear in IoT Forum membership listing and applicant’s (individual or organisation) homepage, if any:

Please scan the completed application form(s) and send to IoT Forum Secretariat.

IoT Forum secretariat contact person:

Name, Last Name / Dr. Francois CARREZ
Postal Address / University of Surrey, FEPS, Stag Hill, GU2 7XH, Guildford, UK
E-mail /
Telephone / +44 (0)148368 9804
Telefax / +44 (0)148368 6011

______

The Article of Association for IoT Forum can be requested through the secretariat contact person or downloaded from the IoT Forumwebsite (

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