Mail Checks To :
ASIDIC
P.O. Box 3212
Maple Glen, PA
19002-8212

Phone and Fax:
(215)-654-9129
E-Mail:
info@asidic.org

ASIDIC Full Member Dues Invoice

Available for organizations with six or more employees engaged in the electronic dissemination of information or in support activities for the electronic information industry or its user community. Members shall be interested in improving information technology and promoting the use of electronic databases.

* Indicates required field

*Organization:

*Organization:

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*Organization:

*Organization:

*Organization:

*Organization:

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*Address:

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*City:

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ZIP or Postal Code:

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ZIP or Postal Code:

ZIP or Postal Code:

ZIP or Postal Code:

ZIP or Postal Code:

ZIP or Postal Code:

ZIP or Postal Code:

*Country:

*Representative's Name:

*Representative's Name:

*Representative's Name:

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*Representative's Title:

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*Representative's Email:

*Representative's Email:

*Representative's Email:

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*Representative's Email:

*Representative's Email:

*Representative's Email:

Representative's Fax:

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Website URL:
will be listed on the Membership page of the ASIDIC Web site

Website URL:
will be listed on the Membership page of the ASIDIC Web site

Website URL:
will be listed on the Membership page of the ASIDIC Web site

Website URL:
will be listed on the Membership page of the ASIDIC Web site

Website URL:
will be listed on the Membership page of the ASIDIC Web site

Website URL:
will be listed on the Membership page of the ASIDIC Web site

Website URL:
will be listed on the Membership page of the ASIDIC Web site

Website URL:
will be listed on the Membership page of the ASIDIC Web site

Alternate Rep. Name:

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