2009 INTELLENET MEMBERSHIP RENEWAL

1 January 09 to 31 December 09
[   ] 1 January 08 to 31 December 08 (due if checked = $100.00)
Amount Due:   $100.00  or   $200.00  (if  '08 [ ] checked)

RETURN THIS SHEET WITH PAYMENT

(Please print name)

YOUR NAME: _____________________________

[ ] The Intellenet group e-mail address is Intellenet-L@yahoogroups.com. This is restricted to membership only and your e-mail address is required to access.

Please take a moment to review your listing on the Membership List section of the Intellenet website. Verify your contact information, specialized skills and language proficiencies at http://www.intellenetwork.org.

NOTE: (Do not fill in unless a listing change is needed.)

ADDRESS: _____________________________________________________________

_______________________________________________________________________

_______________________________________________________________________

PHONE: ______________ FAX: ______________ EMAIL: _________________________

Please use reverse for COMMENTS or contact intellenet@intellenetwork.org with questions.

Prior Agency _____________________ (if any - Fed, State or local LE agency if application.)

PAYMENT OPTIONS:

[ ] Credit Card:   ____ Visa  ____ Mastercard  ____ American Express  ____ Discover
     Card #: __________________________  Exp. Date: ____/____  Security Code: _____
     Card Holder's Name: _____________________________________ (as it appears on card)
     Billing Address: ________________________________________________________
     City:_________________________________  State: ________  Postal Code: _______

[ ] Check: ALL CHECKS MUST BE DRAWN ON U.S. BANKS
                   Make checks out to Intellenet and send to:

Mail to: Intellenet

P.O. Box 350

Gladwyne, PA 19035

USA

Thank you for your renewal!

[ ]   I renew my pledge to abide by our Code of Ethics and Bylaws. (Latest versions on website.)