Membership Application - Consortium for Service Innovation

Company Name*

Website*

Person Authorizing this Membership*

First Last

Title*

Email*

Phone*

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Membership Level*

Benefactor ($45,000 per year)
Sponsor ($23,000 per year)
Participant Plus ($16,000 per year)
Participant ($9,900 per year)
Regional Participant - Europe ($4,950 per year)

Membership dues are used to finance the past and future work of the Consortium. Your dues give you access to a wealth of information developed by the members and the staff of the Consortium over the past years. It also gives you access to the white papers that will be created, discounts on member services and, based upon your level of membership, access to Consortium program meetings over the coming 12 months. Membership dues are non-transferable, non-refundable and the Consortium can make no guarantee about future deliverables or activities.

Method of Payment*

Operations Manager Jill DeGraff will be in touch to complete payment.

How did you hear about the Consortium? If you have any other comments or questions (or a P.O. number), please enter below.

By submitting this application, I indicate that I have read and understood the Rules of Conduct and understand that all members must abide by those rules. I understand that my membership is for 12 months from the date I join.

Phone

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