Name
Prefix
First *
Middle
Last *
Suffix
Title
Business Address
Business Name*
Address *
City *
State*	[Select State] APO Japan Alabama Alaska Alberta American Samoa Arizona Arkansas British Columbia California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Manitoba Maryland Massachusetts Michigan Military Mail (Americas) Military Mail (Europe) Military Mail (Pacific) Minnesota Mississippi Missouri Montana Nebraska Nevada New Brunswick New Hampshire New Jersey New Mexico New York Newfoundland North Carolina North Dakota Northwest Territories Nova Scotia Ohio Oklahoma Ontario Oregon Pennsylvania Phillipine Island Phillipines Prince Edward Island Puerto Rico Quebec Rhode Island Saskatchewan South Carolina South Dakota Surrey Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Yukon Territory
Zip Code*
Country	USA Canada India Japan Republic of South Africa United Kingdom
Phone *
Fax
E-Mail *
Type of Organization	IT Provider IT User Public Entity or Agency
NAICS Codes Select all that apply Semiconductor & Electronic Equipment Semiconductor Machinery Manufacturing Electron Tub Manufacturing Bare Printed Circuit Board Manufacturing Semiconductor & Related Device Manufacturing Electronic Capacitor Manufacturing Electronic Resistor Manufacturing Electronic Coil, Transformer and other inductor Manufacturing Electronic Connector Manufacturing Printed Circuit Assembly (Electronic Assembly) Manufacturing Other Electronic Component Manufacturing Communications & Media Equipment Telephone Apparatus Manufacturing Radio & Television Broadcasting & Wireless Communications Equipment Manufacturing Other Communications Equipment Manufacturing Fiber optic Cable Manufacturing Other Communication & Energy Wire Manufacturing Media Recording Equipment Electronic Computer Manufacturing Computer Storage Device Manufacturing Computer Terminal Manufacturing Other Computer Peripheral Equipment Manufacturing Audio & video Equipment Manufacturing Software Reproducing Prerecorded Compact Disc (except software) Tape and Record Reproducing Magnetic and Optical Recording Media Manufacturing Media Services Radio networks Radio stations Television Broadcasting Cable & Other Subscription Programming Communications & Network Services Wired Telecommunications Carriers Paging Cellular & Other Wireless Telecommunications Telecommunications Resellers Satellite Telecommunications Cable & Other Program Distribution Other Telecommunications Software & Computer Services Software publishers Internet Publishing & Broadcasting Internet Service Providers Data Processing and Related Services Custom Computer Programming Services Computer Systems Design Services Computer Facilities Management Services Other Computer Related Services Internet & Data Services
Level of Membership
Sponsor underwriters of ITCND $5,000.00 Partner significant contributors to ITCND $2,500.00 Member individual, business or entity that is dependent on or has a stake in information technology 401+ employees $1,500.00 Member 201-400 employees $750.00 Member 51-200 employees $500.00 Member 11-50 employees $250.00 Member 1-10 employees $100.00 Student for any student who supports the goals of ITCND $10.00