IAB Brand Membership Application

Applicant Information

Company Name (include full legal name)

Date

Enter in MM/DD/YYYY

Company Headquarters (Street)

City

State

Zip

Country

Telephone

Company Website

Primary Contact First Name

Primary Contact Last Name

Title

Primary Contact Email

By checking this and typing my name on this Interactive Advertising Bureau, Inc. (“IAB”) Membership Application, I represent that I have the authority to cause applicant Company to become a member of IAB.

Signature

First and Last Name

Title

Membership in IAB is subject to approval by the IAB Board of Directors or a Committee thereof.

IAB will contact your Primary Contact if for any reason we require additional information from you.

All Company contacts on this page will receive IAB newsletters, email updates, and announcements.

To change your preferences, please e-mail [email protected]

Contact Information