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2011 Membership Application PART 1

Individual Membership
Student Membership
(Students must provide proof of
By joining PMI, you agree to adhere to the Project Management Institute Code of Ethics and current enrollment. Do not send
Professional Conduct. The Code can be viewed by visiting www.PMI.org. separately. Student membership
enrollments are subject to
verification.)
Please type or print clearly. Date ______/ ______/ 2011
Have you previously been a member of PMI?
No Yes Year of last membership If yes, what was your previous ID#?

PREFIX (MR., MRS., MS., DR.) 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 2)

CITY STATE/PROVINCE ZIP/POSTAL CODE COUNTRY

Home Address

STREET ADDRESS (LINE 1)

STREET ADDRESS (LINE 2)

CITY STATE/PROVINCE ZIP/POSTAL CODE COUNTRY

Contact Information

PRIMARY E-MAIL SECONDARY E-MAIL

BUSINESS PHONE (WITH COUNTRY CODE, AREA CODE AND EXT.) FAX (WITH COUNTRY CODE AND AREA CODE)

HOME PHONE (WITH COUNTRY CODE AND AREA CODE) MOBILE PHONE (WITH COUNTRY CODE AND AREA CODE) TOLL-FREE PHONE

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

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

IS PROJECT MANAGEMENT YOUR PRIMARY PROFESSION? Yes No

I would like to: What is your preferred mailing address? Home Business
Receive promotional messages from PMI about PMI products, services, and events
What is your preferred renewal billing address? Home Business
Be included in 3rd party postal mailing lists

Your New Member Kit will be mailed to you.

Please Complete Part 2

 2011 Membership Application PART 2

Join PMI online using a credit card @ PMI.org

_______________________________________________________________
Your Name
DUES INFORMATION: One full year membership
What is your organization’s (050) Supply Chain
Amounts in U.S. dollar and euro.
primary business activity (049) Systems Security U.S. dollar euro
(019) Telecommunications
(industry)? (020) Transportation
(052) Urban Development OPTION 1 – PMI Individual Membership
Construction $ 119.00 € 100.00
(021) Utilities PMI Individual Member Dues
(002) Commercial/Heavy Industrial
(047) Web Technology
(001) Residential
(022) Other ______________
OPTION 2 – PMI Student Membership
(003) Other ______________
PMI Student Member Dues $ 30.00* € 25.00*
Resources
*MUST ATTACH verification of current enrollment in
(023) Agriculture What category best describes a degree-granting program. PMI will not process
(027) Coal/Gas/Oil your job function? your membership without this documentation.
(025) Ferrous Mining Do not send separately.
Engineering
(024) Forestry (157) Chemical Dues Calculation (Enter amount from option 1, or 2 above)
(026) Non-Ferrous Mining (151) Civil
Manufacturing (152) Electrical Membership Dues $_____.__ € _____.__
(028) Automotive (153) Electronics
(029) Chemical (154) Environmental Application Fee $ 10.00 € 10.00
(030) Concrete/Clay/Glass/Stone (155) Industrial (Applies to New and Rejoining Members)
(031) Electrical/Electronic (156) Mechanical
Component Fees (Visit www.PMI.org for component list and fees)
(032) Food (150) Other ____________
(033) Machinery/Metals Management PMI Chapter Name(s) _____________________ $_____.__ € _____.__
(034) Paper (102) Communications
(035) Petroleum PMI Community Name(s) ________________ $_____.__ € _____.__
(149) Configuration
(040) Pharmaceutical (104) Contract/Procurement Optional Air Mail $60.00/ € 50.00 $_____.__ € _____.__
(036) Plastics (101) Corporate/Administrative (for PMI publication mailing outside North America)
(037) Textiles/Fabrics (105) Cost Optional Donation to the PMI Educational $_____.__ € _____.__
(038) Wood (148) Critical Chain Foundation
(039) Other ______________ (147) Earned Value
(108) Human Resources If applicable, calculate Canadian Tax (see below) $_____.__ € _____.__
Other Business Activities
(045) Academia (109) Information/Computer Total Amount Enclosed $_____.__ € _____.__
(004) Aerospace (112) Materials
(005) Architecture/Design (114) Project/Program
(006) Arts/Entertainment/ (117) Quality METHOD OF PAYMENT:
Broadcasting (118) Records
(120) Risk/Safety Payment must accompany application. Purchase Orders not accepted.
(046) Automation Systems
(007) Business Mgmt Svcs./ (121) Scope/Technical We accept cheques made payable to PMI in euro or U.S. dollars drawn on
Mgmt Consulting (122) Site/Facility
(124) Time Mgmt/Scheduling/ a U.S. bank, bank transfers or the following credit cards:
(053) City Management
(008) Computers/Software/DP Planning
VISA MasterCard American Express Diners Club Discover
(044) Consulting Other
(009) Defense (103) Consulting Card Number: _____________________________________________
(048) E-business (106) Distribution
(010) Economics/Finance (107) Finance Exp. Date: ______ /_______
(011) Education/Training (127) Financial Services (MM) (YY)
(041) Engineering (110) Legal
(012) Environmental/Waste/Sewage (111) Marketing/Business Signature: ____________________________________________
(042) Financial Services Development/Sales
(013) Health/Human/Social Services (113) Production Do not send cash.
(043) Information Technology (115) Project Accounting/Audit Please remit total payment in one currency, U.S. dollar or euro.
(051) International Development (116) Public Relations
PMI is an individual membership organization. All membership fees are
(014) Legal (119) Research/Product
nonrefundable, nontransferable and subject to change.
(015) Printing/Publishing Development
(016) Public Administration/ (056) Retail
Government (128) Service & Outsourcing CANADIAN TAX INFORMATION
(017) Real Estate/Insurance (123) Teaching/Training In accordance with Canadian tax law, taxes are collected on member dues and application fees
(018) Recreation (146) Web Strategist/Technologist relating to PMI and the following chapters: Canada’s Technology Triangle (CTT); Lakeshore;
(125) Other _______________ Durham Highlands; New Brunswick; Levis; Manitoba; Montreal; Northern Alberta;
If remitting payment by credit card, please complete the application and include credit card details. Nova Scotia; Ottawa Valley; Regina/ S. Saskatchewan; South Western Ontario; Southern
You may either save the application to your desktop and email it to membership.services@pmi.org, Alberta, and Southern Ontario. Canadian residents should include applicable taxes in the space
or print and fax the application to 1-610-819-0746. provided. The rate of tax charged varies depending upon the province address you use.
Tax calculations by province are 15% for Nova Scotia; 13% for New Brunswick, Newfoundland
If paying by personal or company check (made payable in U.S. Dollars drawn on a U.S. Bank),
Labrador and Ontario; 12.88% for Quebec; 12% for British Columbia; 5% for all other provinces
please print the application and return to the address listed below.
If your employer is paying for your membership and has been granted tax-exempt status by
Return Completed Form with Payment to: the appropriate Canadian authorities, you will not be able to submit your application on-line.
Project Management Institute, 14 Campus Boulevard You will need to mail or fax your membership application along with a tax-exempt certification
meeting the specifications of the Canadian government.
Newtown Square, Pennsylvania 19073-3299 USA
Or fax to: 1 610 819 0746
• GST/HST Registration #:897944807RT0001 • QST Registration #:1202723001TQ0001
Asia Pacific Applicants Return Completed Form with U.S. Dollar Payment to:
Project Management Institute, Asia Pacific Service Centre ©2010 Project Management Institute, Inc. All rights reserved.
73 Bukit Timah Road, #04-01 Rex House Singapore 229832 “PMI”, the PMI logo, “PM Network”, and “PMI Today” are registered marks of Project Management Institute, Inc.
Or fax to: +65 6336 6449 064-001-2010