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ACM STUDENT MEMBERSHIP APPLICATION FOR INDIVIDUALS RESIDING

IN ECONOMICALLY DEVELOPING COUNTRIES


Education
Member Information
ACM Student Membership $18 (USD) Universidad
Simón Bolívar
Includes a 12 month Online subscription to Communications of the ACM, an Name of School
online
subscription to Member Net, Tech News, and Carreer News, a print Please check one
subscription to Crossroads, a subscription to the ACM Digital Library (all fully High School
searchable and downloadable), plus free Online Books, and free Online
Courses and all other benefits of ACM Memberships All students are eligible College
3rd Year
Check here if submmiting a membership renewal. Member#
4th Year
Name
(First, Last, M.I.) 5th Year

Address Graduate Student

City Masters Program


Doctorate Program
Postal
code
Country Colombia
Major
Email

Phone 57-5 Expected Month/Year


(include country/city code) of Graduation
Age Range
Purpose of ACM 18-21 22-25 26-30
ACM is dedicated to:
31-35 36-40 41-45
1) advancing the art, science, engineering, and application of information
technology; 46-50 51-55 56-59
2) fostering the open interchange of information to serve both professionals 60 +
and the public; and
3) promotion the highest professional ethics standards.* Do you belong to an ACM
Student Chapter ?
**Note: ACM's Code of Ethics can be accessed at www.acm.org/serving/
Yes No

I agree to subscribe to the


Questions? Email us at acmhelp@acm.org or call Purpose of ACM
+1-212-626-0500 (8:30am-4:30pm EST)
Visit ACM at www.acm.org

Signature
CODE LEVEL: 3

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