Fields marked with an asterisk (*) 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.
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.
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.
The X12 Billing Contact is typically your Accounts Payable Department Contact or generic email address. The X12 Billing Contact will be copied on all membership renewal notifications and dues payment receipts.
X12 includes a number of specifically focused subcommittees. Use the boxes below to indicate an intention to participate in a committee’s collaborations.
- X12C - Communcations and Controls
- X12F - Finance
- X12I - Transportation
- X12J - Technical Assessment
- X12M - Supply Chain
- X12N - Insurance
- B2X - Business to Everything
- Select None if if do not plan to participate in standards development.
For statistical purposes, each applicant must self-select a classification. The drop down list below displays the classifications. Select the classification that best describes the member applicant.
By submitting this form I acknowledge that I have reviewed and will comply with X12's Policies and Procedures, including but not limited to X12 Bylaws, Membership, and Intellectual Property policies.