Membership Application
Eligibility and Privileges of Membership Levels
Executive Member
 Eligibility: Organizations actively supplying or using Modbus-based devices
 Voting Privileges: Twenty-five (25) votes per
executive member organization
 Preferential, extended company listing on the
Modbus website
 Preferential, extended device listings on the
Modbus website
 Eligible to publish Modbus-related application stories, product announcements, and company news
on Modbus website and in Modbus newsletter
 Eligible for discounts on Modbus conformance
testing, educational programs, banner advertising,
and select other programs/activities
 Eligible for Conformance Self-Test Program
 Participates in Modbus Logo Program
 Participates in Modbus Organization technical
committees, trade show exhibition opportunities,
and demonstrations.
 Free Modbus TCP Developers Toolkit
General Member
 Eligibility: Organizations actively supplying or using Modbus-based devices
 Voting Privileges: One (1) vote per general
member organization
 Preferential, extended company listing on the
Modbus website
 Preferential, extended device listings on the
Modbus website
 Eligible to publish Modbus-related application

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General Member, cont’d
stories, product announcements, and company
news on Modbus website and in
Modbus newsletter
Eligible for discounts on Modbus conformance
testing, educational programs, banner advertising,
and select other programs and activities
Eligible for Conformance Self-Test Program
Participates in Modbus Logo Program
Participates in Modbus Organization technical
committees, trade show exhibition opportunities,
and demonstrations.
Free Modbus TCP Developers Toolkit
Supporting Member
 Eligibility: Systems Integrators, Suppliers, Users,
Educational Institutions, Individuals, Students and
Organizations who do not otherwise qualify for
membership as a General or Executive Member
 Voting Privileges: No
 Preferential, extended company listing on the
Modbus website
 Preferential, extended device listings on the Modbus website
 Eligible to publish Modbus-related application
stories, product announcements, and company
news on Modbus website and in Modbus
newsletter
 Participates in Modbus Logo Program
 Participates in Modbus Organization technical
committees, trade show exhibition opportunities,
and demonstrations.
Terms and Conditions of Membership in The Modbus Organization
The information contained in this application is true and correct, and the Applicant is qualified to apply for
Modbus Organization membership. As a member, the applicant will comply with and abide by the Articles of
Incorporation and Bylaws of The Modbus Organization, as well as other association and membership rules that
may be in effect from time-to-time. Membership in The Modbus Organization, if approved, will be subject to
Applicant’s continuing compliance.
The above-designated individual is authorized to receive and distribute Modbus Organization communications
and to vote on matters presented for ballot to the general membership, if applicable. The Applicant will not divulge information identified as confidential by The Modbus Organization to any third party and will use such
information only for membership purposes.
The Modbus Organization may publish or otherwise disclose information concerning its membership, including
possible filings with relevant federal and state agencies as may be deemed advisable by the The Modbus Organization Board of Directors from time-to-time, and the undersigned applicant hereby appoints the President
of The Modbus Organization, or his/her successors, as the Applicant’s agent to approve the form and substance of any such publication or disclosure.
Participation in The Modbus Organization Technical Committees may be subject to additional requirements,
COMPANY INFO
Company Name
State or Country of Incorporation
Address of Principal Office
Web Address
Address, cont’d.
Telephone
City/State/Postal Code/Country
Fax
CONTACT
Designated Individual’s Name
Mailing Address (if different)
City/State/Postal Code/Country
MEMBERSHIP
Telephone
Fax
E-mail
Category (see reverse for eligibility and privileges)
Executive Member
General Member
Supporting Member - Supplier/User
Supporting Member - Integrator
Supporting Member - Educational Institution
Supporting Member - Individual
Supporting Member - Student
school attending___________________
Committee Interests
Conformance Test
Real time
Marketing
Security
Dues Schedule
Executive Member
General Member
1000+ employees
100-1000 employees
<100 employees
$40,000
$3,500
$2,500
$1,500
Supporting Memberships:
- Integrator or Manufacturer
- Individual
- Student
$500
$60
$35
Membership fees are non-refundable, due upon application, payable to The Modbus Organization.
Application will not be processed without payment or purchase order. Annual membership is renewed automatically and invoiced and due payable on the anniversary date of the membership unless The Modbus Organization is notified of a desired change in status in writing by the member. Applications are subject to acceptance by The Modbus Organization Board of Directors. Membership rights and privileges are contingent upon
receipt of payment.
Contributions or gifts to The Modbus Organization are not tax deductible, but may be deductible as ordinary
and necessary business expenses.
By having an authorized representative sign this application, the Applicant agrees and
represents that it has read, acknowledged and agreed with the Terms and Conditions
of Membership in The Modbus Organization on the reverse side.
Signature: _________________________________________________
Printed Name: ______________________________________________
Title: ______________________________________________________
Date: _____________________________________________________
Mail or fax this form to: Modbus Organization, PO Box 628, Hopkinton, MA 01748-0628 • Fax: +1-508-435-7172
Modbus Organization, Inc. Payment Information
To pay by check (drawn on U.S. bank only):
Make checks payable to Modbus Organization, Inc. and mail with your completed application to:
Modbus Organization, Inc.
PO Box 628
Hopkinton, MA 01748
To pay by wire transfer:
Please contact us to arrange payment by wire transfer (e-mail info@modbus.org).
To pay by credit card:
Return application with the following fields completed:
Credit card type: MasterCard
Visa
Credit card number:
Security Code:
Expiration Date:
Name on
Credit Card:
Credit card billing address:
Signature:
Printed Name:
To pay by purchase order:
Send your purchase order and completed application to the Modbus Organization by fax or e-mail:
Fax (+1 508-435-7172) or e-mail (info@modbus.org)