X12 Member Application

To apply for an X12 membership, complete and submit the following application form. The application will be reviewed and verified, then you will be notified of the next steps. You will receive a response within three business days of submission.

If you have any questions, please email info@x12.org.

Fields Marked with an * are required
 
Individuals meeting the requirements for Individual Membership (see below), enter their name and mailing address below. All other applicants enter their organization’s legal name and mailing address below.
* Member Name
* Member Street Address
* Member City
* Member State
* Member Zip/Postal Code
* Member Country
 
The drop down list below displays the X12 membership categories and associated annual dues. Hovering over a category in the drop down list displays the criteria for the category. Select the category that best describes the member applicant.
* Category and Sub-Category
 
Each member is represented by a Primary Representative. The Primary Representative will receive all official communications from X12 including membership notices and ballots. The Primary Representative is the Member’s Designee and speaks for the member in all X12 matters. Submission of contact information below constitutes authorization to send official X12 communications. X12 does not sell or otherwise distribute contact information to external organizations.
* Primary Representative Name
Primary Representative Title
* Primary Representative Email
* Primary Representative Phone
 
The Alternate Representative speaks for the member when the Primary Representative is not available. Individual memberships are not permitted to have Alternate Representatives. All other members may elect to name an Alternate Representative.Submission of contact information below constitutes authorization to send official X12 communications. X12 does not sell or otherwise distribute contact information to external organizations.
Alternate Representative Name
Alternate Representative Title
Alternate Representative Email
Alternate Representative Phone
 
X12 includes a number of specifically focused subcommittees. Use the checkboxes below to indicate an intention to participate in a subcommittee’s collaborations.
* Subcommittee(s)
 
Enter your Standard Industrial Classification.
SIC Code
 
For statistical purposes, each applicant must self-select a classification. The drop down list below displays the classifications. Hovering over a classification in the drop down list displays the associated definition. Select the classification that best describes the member applicant.
* Classification
 
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