City: ____________________ State:__________ Zip: ____________
Country: ____________ E-Mail:______________________________
Phone: ________________________ Fax:______________________
Complete all information and mail this document, along with a check or money order for dues, to Director of Member Services, US Internet Industry Association, 1800 Diagonal Road, Suite 600, Alexandria, VA 22314. The form may also be sent via fax (703-647-6009) or
Dues for Individual Professional
Members are $500 per year.
Dues are payable by check or money order and must accompany the membership application. This
dues payment is not deductible as a charitable contribution.
However, for most members this fee is deductible as a business
expense. Up to twenty percent of member dues will be used for
lobbying expenses on behalf of the members. Membership is not transferable or refundable.
For further information contact USIIA at (703) 647-7440.