PROGRESS E-Mail Group PEG Corporate Membership Form c/o PEG Holdings Fax: 630-523-5764 840 W. Lake Street Unit 406 Phone: 630-523-5762 Roselle, IL 60172-2889 FEIN: 36-4230086 Corporate Membership is based on the number of users (Developers, DBAs, Analysts, Architects, Consultants, etc.) employed by an organization. For individual memberships use http://www.peg.com/mbrform.txt Contact Name : _____________________________________________________ Company: _____________________________________________________ Address: _____________________________________________________ : _____________________________________________________ : _____________________________________________________ City : ______________________________ State: ______ Postal : _____________________ Country: ____________________ E-Mail : _________________________________________________________ Payment Method: ____ Request Invoice PO Number: ________________________________________ ____ Check Enclosed ____ VISA ____ MasterCard ____ American Express Card No: ____________________________________________ Expires: ___________ Signature: ________________________________________________________________ Amount : ____ 1 - 10 $600.00 / year ____ 61 - 80 $3600.00 / year ____ 15 - 20 $800.00 / year ____ 81 - 100 $4400.00 / year ____ 21 - 25 $1000.00 / year ____ 101 - 120 $5200.00 / year ____ 26 - 30 $1300.00 / year ____ 121 - 140 $6000.00 / year ____ 31 - 35 $1900.00 / year ____ 141 - 160 $7000.00 / year ____ 36 - 40 $2200.00 / year ____ 161 - 180 $8000.00 / year ____ 41 - 50 $2600.00 / year ____ 181 - 200 $9000.00 / year ____ 51 - 60 $3000.00 / year ____ Over 200 $10000.00 / year