Generic App Feb 2010

 

 For faster faster processin processing, g, join PMI PMI online using using a credit credit card @ PMI.org PMI.org  Select   Your Membership Member ship Option

2010 Membership Application

Individual Membership Student Membership

PART 1

(Students must enclose proof of current enrollment. Do not send separately.)

 By joining PMI, you agree to adhere to the Project Management Institute Code of Ethics and Professional Conduct. The Code can be viewed by visiting www.PMI.org. Please type or print clearly.

Date ______/ ______/ 2010

Have you previously been a member of PMI?

 

No

Yes

Year of last membership

PREFIX (MR., MRS., MS., DR.)

If yes, what was your previous ID#?

FIRST NAME (Maximum of 20 letters) MI

LAST NAME (Maximum of 20 letters)

SUFFIX 

PLEASE PRINT NAME AS YOU WANT IT TO APPEAR ON YOUR MEMBERSHIP CERTIFICATE JOB TITLE

COMPANY/ORGANIZATION

Business Address STREET ADDRESS (LINE 1) STREET ADDRESS (LINE 1) CITY

STATE/PROVINCE

ZIP/POSTAL CODE

COUNTRY

STATE/PROVINCE

ZIP/POSTAL CODE

COUNTRY

Home Address STREET ADDRESS (LINE 1) STREET ADDRESS (LINE 1) CITY

Contact Information PRIMARY E-MAIL BUSINESS PHONE HOME PHONE

SECONDARY E-MAIL  (WITH COUNTRY CODE, AREA CODE AND EXT.) 

(WITH COUNTRY CODE AND AREA CODE)

FAX MOBILE PHONE

(WITH COUNTRY CODE AND AREA CODE)

(WITH COUNTRY CODE AND AREA CODE)

 TOLL-FREE PHONE

By supplying the fax information above, you consent to being contacted by PMI at the f ax number provided.

General Information HOW MANY YEARS HAVE YOU BEEN PRACTICING PROJECT MANAGEMENT?

If you do not wish to receive certain types of communications from PMI, please check below:

   

IS PROJECT MANAGEMENT YOUR PRIMARY PROFESSION?

What is your preferred mailing address?  

Home

What is your preferred renewal billing address?  

 Yes

No

Business Home

Business

E-mail communications regarding PMI products, services and events Postal mail communications regarding PMI products, services and events

 Your

New Member Kit will

be mailed to you. PM Network ® and PMI

®

   

Phone or text messages regarding PMI products, services and events E-mail or postal mail communications from third party associates of PMI

Today   will begin arriving in approximately six to eight weeks.

Please Complete Part 2

 

2010 Membership Application

PART 2

 Join PMI online online using using a credit credit card card @ PMI.org PMI.org  Your Name

What is your organization’s primary business activity (industry)? Construction  (002) Commercial/Heavy Industrial

 (001) Residential  (003) Other______________ Other________________ __ Resources (023) Agriculture  (027) Coal/Gas/Oil  (025) Ferrous Mining   (024) Forestry   (026) Non-Ferrous Mining  Manufacturing   (028) Automotive  (029) Chemical  (030) Concrete/Clay/Glass/Stone  (031) Electrical/Electronic  (032) Food  (033) Machinery/Metals  (034) Paper   (035) Petroleum  (040) Pharmaceutical  (036) Plastics

  (037) (038) Textiles/Fabrics Wood  (039) Other______________ Other________________ __ Other Business Activities (045) Academia  (004) Aerospace  (005) Architecture/Design  (006) Arts/Entertainment/ Broadcasting   (046) Automation Systems  (007) Business Mgmt Svcs./ Mgmt Consulting   (053) City Management  (008) Computers/Softw Computers/Software/DP are/DP  (044) Consulting   (009) Defense  (048) E-business  (010) Economics/Finance  (011) Education/Training   (041) Engineering   (012) Environmental/Waste/Sewage (042) Financial Services  (013) Health/Human/  Social Services  (043) Information Technology   (051) International Development  (014) Legal  (015) Printing/Publishing   (016) Public Administration/ Government  (017) Real Estate/Insurance (018) Recreation

DUES INFORMATION: One full year membership  (050) Supply Chain  (049) Systems Security   (019) Telecommunications  (020) Transportation  (052) Urban Development  (021) Utilities Technology    (047) (022) Web Other________________ Other______________ __

 Amounts in U.S. dollar and an d euro.

OPTION 1 – PMI Individual Membership $ 119.00

€

 100.00

$ 30.00*

€

  25.00*

Membership Dues (Enter amount from option 1, or 2 above)

$_____.__

€

_____.__

Application Fee

$ 10.00

€

  10.00

PMI Chapter Name(s)___________________________ Name(s)___________________________ $_____.__

€

_____.__

PMI Community Name(s) Name(s) ____________ _______________________ ___________ $_____.__

€

_____.__

$_____.__

€

_____.__

Optional Donation to the PMI Educational Foundation If applicable, calculate Canadian Tax (see below)

$_____.__ $_____.__

€ €

_____.__ _____.__

Total Amount Enclosed 

$_____.__

€

_____.__

PMI Individual Member Dues

OPTION 2 – PMI Student Membership PMI Student Member Dues

What category best describes  your job function? Engineering (157) Chemical (151) Civil (152) Electrical  (153) Electronics  (154) Environmental  (155) Industrial  (156) Mechanical  (150) Other____________ Management (102) Communications  (149) Configuration  (104) Contract/Procurem Contract/Procurement ent  (101) Corporate/Administrative

 (105) Cost  (148) Critical Chain  (147) Earned Value (108) Human Resources

 (109) Information/Co Information/Computer  mputer   (112) Materials  (114) Project/Program  (117) Quality   (118) Records  (120) Risk/Safety   (121) Scope/Technic Scope/Technical al  (122) Site/Facility   (124) Time Mgmt/Scheduling/ Planning  Other   (103) Consulting   (106) Distribution  (107) Finance  (127) Financial Services  (110) Legal  (111) Marketing/Business Development/Sales  (113) Production  (115) Project Accounting/Audit  (116) Public Relations  (119) Research/Product Development  (056) Retail  (128) Service & Outsourcing   (123) Teaching/Training   (146) Web Strategist/Technologist  (125) Other______________ Other_________________ ___

Return Completed Form with Payment to:

Project Management Institute, 14 Campus Boulevard Newtown Square, Pennsylvania 19073-3299 USA Or fax to: 1 610 819 0746 EMEA Applicants Return Completed Form with Euro or U.S. Dollar Payment to:

Project Management Institute, EMEA Service Centre 300, Avenue de Tervueren B-1150 Brussels, Belgium Or fax to: +32 2 743 15 50

euro

U.S. dollar

*MUST ATTACH verification of current enrollment in   a degree-granting program. program. PMI will not not process   your membership without this documentation.   Do not send send separately. 

Dues Calculation

(Applies to New and Rejoining Members)

Component Fees (Visit www.PMI.org for component list and fees)  

Optional Air Mail $60.00/€ 50.00 (for PMI publication mailing outside North America)

METHOD OF PAYMENT: Payment must accompany application. Purchase Orders not accepted.

o  We accept cheques made payable to PMI in euro or U.S. dollars drawn on   a U.S. bank, bank transfers or the following credit cards:   VISA

MasterCard

American Express

Diners Club

Discover

Card Number _____________________________________________ (MM) /_______ (YY) Exp. Date _______

Signature ___________ _______________________ _______________________ _______________________ ______________ __

Do not send cash. Please remit total payment in one currency, U.S. dollar or euro. PMI is an individual membership organization. All membership fees are nonrefundable, nontransferable and subject to change.

CANADIAN TAX INFORMATION In accordance with Canadian tax law, PMI collects taxes on member dues, application fees, and the following Canadian chapters: Canada’s Technology Triangle (CTT); Canadian West Coast; Durham Highlands; Lakeshore; Levis; Manitoba; Montreal; Northern Alberta; Nova Scotia; Ottawa Valley; Regina/ S. Saskatchewan; South Western Ontario; Southern Alberta, Southern Ontario and Vancouver Island. Canadian residents should include applicable taxes in the space provided. The rate of tax and the total amount that you owe will vary depending on the province where you have permanent residency. Tax calculations by province are 13% for New Brunswick, Newfoundland, Nova Scotia; 12.88% for Quebec; 5% for all other provinces. If your employer is paying for your membership and has been granted tax-exempt status by the appropriate Canadian authorities, you will not be able to submit your application on-line. You will need to mail or fax your membership application along with a tax-exempt certification meeting the specifications of the Canadian government.

• GST/HST Registration #:897944807RT0001 • QST Registration #:1202723001TQ0001

 Asia Pacific Applicants Return Completed Completed Form with U.S. Dollar Payment to:

Project Management Institute, Asia Pacific Service Centre 73 Bukit Timah Road, #04-01 Rex House Singapore 229832 Or fax to: +65 6336 6449

©2010 Project Management Institute, Inc. All rights reserved. “PMI”, the PMI logo, “PM Network”, and “PMI Today” are registered marks of Project Management Institute, Inc. 064-001-2010