Check One: New Membership Renewal
Name: Title:
Company: Mail Stop:
Company Address:
City: State: Zip:
E-mail Address:
Phone: Fax: URL:
Type of Organization: Corporate Vendor Government Academic Contractor Consultant Other:
Your Role: (check all that apply) Trainer Sales/Marketing Administrator Owner Manager Coordinator Developer Designer Other (Please describe):
Home Address: Home E-mail:
City: State: Zip:
(This information is for our records only. It will not be distributed or used for any other purpose except for ADAPT mailings.)
Individual Membership $50 - Total of 1 member: Member 1:    Email:
Corporate Membership $160 - Total of 5 members: Member 1:  Email: Member 2:  Email: Member 3:  Email: Member 4:  Email: Member 5:  Email:
Membership Payment Method: (payment instructions will follow after submitting this form)	PayPal    Send Check
Have your company publicized in the ADAPT newsletter and website! ADAPT offers 2 different methods of promoting your business: Newsletter Advertising: ADAPT welcomes vendor advertising in our monthly newsletter, which is distributed to more than 200 IT professionals in the New England region. Advertisements are available in the following sizes: Full Page, 1/2 Page, 1/4 Page, or Business Card. More information is available on our Advertising Application. Vendor Directory: Advertise annually in our Vendor Directory found in both our monthly newsletter and on our website for $125. Our website enjoys the traffic of our membership and links to and from other industry sites. Our newsletter is published September through June and distributed to several hundred New England IT professionals. Act now and your message will appear in our upcoming monthly newsletter. Yes! Please contact me about advertising in the ADAPT Newsletter. Yes! Please contact me about advertising in the ADAPT Vendor Directory. Yes! Please contact me about advertising in both the newsletter and directory.