This document is a membership form for the OMICS Group, an open access publisher of science, technology, and medicine e-books and databases. It provides information on annual membership benefits, which include free membership, opportunities to represent one's country/continent as a supporting organization, reduced costs for organizing symposia at OMICS conferences, and reduced open access publication fees in OMICS journals. Members also receive a customized webpage for their organization and increased exposure. The form requests contact and affiliation information to apply for free annual membership with OMICS Group.