U.S. TECHNICAL ADVISORY GROUP AUTOMATION SYSTEMS AND INTEGRATION INTEROPERABILITY, INTEGRATION, AND ARCHITECTURES FOR ENTERPRISE SYSTEMS AND AUTOMATION APPLICATIONS ISO TC 184 U.S. TAG’s MEMBERSHIP Annual (Jan 1-Dec. 31, 2013)

Please check the appropriate box to indicate the TAG’s you would like to join:

U.S. TAG MEMBER CONTACT INFORMATION

Company Name	Primary Contact	Title

Street Address	City, State, Zip or Post Code	Country

Email Address	Phone Number	Fax Number

Alternative Contact	Alternative Phone Number	Alternative Email Address

Please list members and check appropriate participation box:

Full Name Email

Full Name Email

Full Name Email

Full Name Email

Website Update:

Would you like your organizations logo to appear on the U.S. TAG website?

*If yes please email your logo to melissa.hildebrand@eccma.org

METHOD OF PAYMENT

(checks must be payable to ECCMA and be in U.S. dollars drawn on a U.S. bank) (all wire transfers must include a fee of $25.00 added to the total amount)
Card Number:	Security Code:
Expiration Date:	Cardholder’s Name:
Cardholder’s Email (to send receipt):
Billing Address:
Signature:	Date:

Wire Fee (if applicable) $

Total Amount $

Please complete the form and e-mail, fax or mail to Melissa Hildebrand at melissa.hildebrand@eccma.org.