Online form
(Note that you will fill out a preliminary form that will then generate the final form, and will allow you to confirm your input.)

PDF version of the form
Please print out the above PDF file, and fax it to the ICANN Secretary at +1 310 823 8649, or mail it to:

Internet Corporation for Assigned Names and Numbers
Attn: ICANN Secretary
4676 Admiralty Way
Marina del Rey, California 90292
USA

The application form looks like this:

Application for Membership

Country Code Names Supporting Organization (ccNSO)

With this letter, I declare that [name of the ccTLD manager] is the ccTLD manager (as defined in the ICANN bylaws, Article IX(4)(1)*) for the [TLD name] domain, and that I am authorized to sign this application for membership to the ccNSO on behalf of [name of ccTLD manager].

The [name of the ccTLD manager] hereby recognizes the role of the ccNSO within the ICANN structure, and agrees, for the duration of its membership in the ccNSO to:

(a) adhere to the rules of the ccNSO, including membership rules;

(b) adhere to ICANN by laws as they apply to ccTLDs (Article IX and Annexes B and C of the ICANN bylaws; and

(c) pay ccNSO membership fees established by the ccNSO Council.

Membership in the ccNSO is independent of any individual relationship a ccTLD manager has with ICANN or the ccTLD manager's receipt of IANA services. (Article IX(4)(3)).

This form is submitted by [insert name] being the ccTLD manager or a person duly authorized by the ccTLD manager to apply for membership on behalf of the ccTLD manager.

Sincerely,

[signature]

Secondary contact information:

Designated ccNSO representative for ccTLD (if different from above):

* DEFINITION: For the purposes of membership of the ccNSO a ccTLD manager is defined as the organization or entity responsible for managing an ISO 3166 country-code top-level domain and referred to in the IANA database under the current heading of "Sponsoring Organization" (or any later variant) for that country-code top-level domain. (ICANN Bylaws Article IX(4)(1))