JoinModbus.pdf

Membership Application

Eligibility and Privileges of Membership Levels

Executive Member

 Eligibility: Organizations actively supplying or us-

ing Modbus-based devices

 Voting Privileges: Twenty-five (25) votes per

executive member organization

 Preferential, extended company listing on the

Modbus website

 Preferential, extended device listings on the

Modbus website

 Eligible to publish Modbus-related application sto-

ries, product announcements, and company news

on Modbus website and in Modbus newsletter

 Eligible for discounts on Modbus conformance

testing, educational programs, banner advertising,

and select other programs/activities

 Eligible for Conformance Self-Test Program

 Participates in Modbus Logo Program

 Participates in Modbus Organization technical

committees, trade show exhibition opportunities,

and demonstrations.

 Free Modbus TCP Developers Toolkit

General Member, cont’d

stories, product announcements, and company

news on Modbus website and in

Modbus newsletter

 Eligible for discounts on Modbus conformance

testing, educational programs, banner advertising,

and select other programs and activities

 Eligible for Conformance Self-Test Program

 Participates in Modbus Logo Program

 Participates in Modbus Organization technical

committees, trade show exhibition opportunities,

and demonstrations.

 Free Modbus TCP Developers Toolkit

Supporting Member

 Eligibility: Systems Integrators, Suppliers, Users,

Educational Institutions, Individuals, Students and

Organizations who do not otherwise qualify for

membership as a General or Executive Member

 Voting Privileges: No

 Preferential, extended company listing on the

Modbus website

 Preferential, extended device listings on the Mod-

bus website

 Eligible to publish Modbus-related application

stories, product announcements, and company

news on Modbus website and in Modbus

newsletter

 Participates in Modbus Logo Program

 Participates in Modbus Organization technical

committees, trade show exhibition opportunities,

and demonstrations.

General Member

 Eligibility: Organizations actively supplying or us-

ing Modbus-based devices

 Voting Privileges: One (1) vote per general

member organization

 Preferential, extended company listing on the

Modbus website

 Preferential, extended device listings on the

Modbus website

 Eligible to publish Modbus-related application

Terms and Conditions of Membership in The Modbus Organization

The information contained in this application is true and correct, and the Applicant is qualified to apply for

Modbus Organization membership. As a member, the applicant will comply with and abide by the Articles of

Incorporation and Bylaws of The Modbus Organization, as well as other association and membership rules that

may be in effect from time-to-time. Membership in The Modbus Organization, if approved, will be subject to

Applicant’s continuing compliance.

The above-designated individual is authorized to receive and distribute Modbus Organization communications

and to vote on matters presented for ballot to the general membership, if applicable. The Applicant will not di-

vulge information identified as confidential by The Modbus Organization to any third party and will use such

information only for membership purposes.

The Modbus Organization may publish or otherwise disclose information concerning its membership, including

possible filings with relevant federal and state agencies as may be deemed advisable by the The Modbus Or-

ganization Board of Directors from time-to-time, and the undersigned applicant hereby appoints the President

of The Modbus Organization, or his/her successors, as the Applicant’s agent to approve the form and sub-

stance of any such publication or disclosure.

Participation in The Modbus Organization Technical Committees may be subject to additional requirements,

Company Name

State or Country of Incorporation

Address of Principal Office

Web Address

Address, cont’d.

Telephone

City/State/Postal Code/Country

Fax

Designated Individual’s Name

Mailing Address (if different)

City/State/Postal Code/Country

Telephone Fax E-mail

Category (see reverse for eligibility and privileges)

Executive Member Supporting Member - Educational Institution

General Member Supporting Member - Individual

Supporting Member - Supplier/User Supporting Member - Student

Supporting Member - Integrator school attending___________________

Committee Interests

Conformance Test Marketing

Real time Security

Dues Schedule

Executive Member

$40,000

Supporting Memberships:

General Member

- Integrator or Manufacturer

$500

1000+ employees

$3,500

- Individual

$60

100-1000 employees

$2,500

- Student

$35

<100 employees

$1,500

Membership fees are non-refundable, due upon application, payable to The Modbus Organization .

Application will not be processed without payment or purchase order. Annual membership is renewed auto-

matically and invoiced and due payable on the anniversary date of the membership unless The Modbus Or-

ganization is notified of a desired change in status in writing by the member. Applications are subject to accep-

tance by The Modbus Organization Board of Directors. Membership rights and privileges are contingent upon

receipt of payment.

Contributions or gifts to The Modbus Organization are not tax deductible, but may be deductible as ordinary

and necessary business expenses.

By having an authorized representative sign this application, the Applicant agrees and

represents that it has read, acknowledged and agreed with the Terms and Conditions

of Membership in The Modbus Organization on the reverse side.

Signature: _________________________________________________

Printed Name: ______________________________________________

Title: ______________________________________________________

Date: _____________________________________________________

Mail or fax this form to: Modbus Organization, PO Box 628, Hopkinton, MA 01748-0628 • Fax: +1-508-435-7172

Modbus Organization, Inc. Payment Information

To pay by check (drawn on U.S. bank only):

Make checks payable to Modbus Organization, Inc. and mail with your completed application to:

Modbus Organization, Inc.

PO Box 628

Hopkinton, MA 01748

To pay by wire transfer:

Please contact us to arrange payment by wire transfer (e-mail info@modbus.org).

To pay by credit card:

Return application with the following fields completed:

Credit card type: MasterCard

Visa

Credit card number:

Expiration Date:

Security Code:

Name on

Credit Card:

Credit card billing address:

Signature:

Printed Name:

To pay by purchase order:

Send your purchase order and completed application to the Modbus Organization by fax or e-mail:

Fax (+1 508-435-7172) or e-mail (info@modbus.org)

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