Login Information
User ID: (Assign yourself a user ID)
Password: (Assign yourself a password) (Minimum 4 characters)
Confirm Password: (Enter the password again)
Contact Information
Official Business Name:
Authorized Business Official:
Title:
Complete Mailing Address:
City:
State:
Zip Code:
Country:
Contact Person:
Telephone:
EXT:
Facsimile:
Contact Person's
E-mail:
Business Website
Address:
Payment
Information All information
will be kept strictly confidential by ICDL.
Purchase Order Number:
Billing Address:
City:
State:
Zip Code:
Country:
Wire Transfer Bank
Account Number:
Authorization As an authorized official of the above company, I
hereby agree to become a Business Associate Member of the ICDL, Inc. and
understand that the annual membership fee for my company is USD $650.00. I
also understand that the payment terms are net 30.
Full Name:
Official Title:
