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This form is the first step in determining how you can become more involved with CIMIT.  Based on your selections below, we match you with the appropriate staff member who will contact you to discuss our three membership options, which are:

• Collaborating companies join the Industry Liaison Program (ILP)
• Individuals join CIMIT Friends
• Researchers join through the CIMIT Awards Program

People in other categories may also use this form to request more information on CIMIT's work.

* Name:
Position:
Department:
* Company/Institution:
*Mailing Address:
Address (cont.):
*City:
*State:
*Zip:
* E-mail:
Phone Number:
Ignore this text box. It is used to detect spammers. If you enter anything into this text box, your message will not be sent.	( * ) - Denotes a required field

I am: (required)

	in academia/research	Researchers join through the CIMIT Awards Program
	a company representative	Collaborating companies join through the Industry Liaison Program
	an interested individual	Individuals join through CIMIT Friends
	in government or military
	other (please specify):

Please tell us about your interest in CIMIT and how we can help: