Membership Form – ATHEN (Access Technology Higher Education Network)

Membership Year: January 1 – December 31 of each year.

If you join during the months of October, November, or December, your membership will cover the remainder of the current year as well as the entire following year.

Applicant Information

Name(Required)

First Last

Title(Required)

Institution / Organization(Required)

Email(Required)

Address(Required)

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

Website

Select Your Membership Type

Please select your desired membership type from the list below. You can view a description of each membership type and the associated benefits by viewing the memberships overview page (opens in new window)

Membership Type(Required)

Professional ($100/year)

Institutional ($200/year)

Associate/Partner ($150/year)

Student ($25/year)

Institutional Membership Information

Designate a Voting Member

a single voting member must be identified for your institutional membership. Please specify this individual’s information using the fields below.

I will serve as my institution’s voting member

Name of Voting Member(Required)

Email of Voting Member(Required)

Add Institutional Members

Please provide the name and email of individuals you would like to add to your institution’s membership. You can always add additional members by emailing [email protected].

Institutional Members

Row ID	Member’s Full Name	Member’s Email	Actions

There are no Members.

Payment Information

Select Your Payment Method

Payment information is collected using this form, but you will receive an email shortly to confirm next steps necessary for completing your payment and registration.

Payment Method(Required)

Credit Card

Check

Purchase Order

Check Number

Purchase Order Number

Billing Contact Information

I am the billing contact for this membership

Name of Billing contact(Required)

Email for Billing Contact(Required)

Phone for Billing Contact(Required)

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