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2010 Membership Application PART 1

Individual Membership
Student Membership
(Students must enclose proof of
By joining PMI, you agree to adhere to the Project Management Institute Code of Ethics and Professional Conduct. current enrollment. Do not send
separately.)
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 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 1)

CITY STATE/PROVINCE ZIP/POSTAL CODE COUNTRY

Home Address

STREET ADDRESS (LINE 1)

STREET ADDRESS (LINE 1)

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

If you do not wish to receive certain types of communications from PMI, What is your preferred mailing address? Home Business
please check below:
What is your preferred renewal billing address? 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 Today® will begin arriving in approximately six to eight weeks.
E-mail or postal mail communications from third party associates of PMI

Please Complete Part 2

 2010 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 PMI Individual Member Dues $ 119.00 € 100.00
(002) Commercial/Heavy Industrial (021) Utilities
(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
(026) Non-Ferrous Mining (151) Civil Dues Calculation
Manufacturing (152) Electrical Membership Dues (Enter amount from option 1, or 2 above) $_____.__ €_____.__
(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 PMI Community Name(s) _______________________ $_____.__ €_____.__
(035) Petroleum (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 Foundation $_____.__ €_____.__
(038) Wood (148) Critical Chain
(039) Other________________ If applicable, calculate Canadian Tax (see below) $_____.__ €_____.__
(147) Earned Value
Other Business Activities (108) Human Resources
Total Amount Enclosed $_____.__ €_____.__
(045) Academia (109) Information/Computer
(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 o W
 e 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 (MM) /_______
(YY)
Exp. Date _______
(011) Education/Training (127) Financial Services
(041) Engineering (110) Legal
(012) Environmental/Waste/Sewage (111) Marketing/Business Signature ________________________________________________
(042) Financial Services Development/Sales
(013) Health/Human/ (113) Production Do not send cash.
Social Services (115) Project Accounting/Audit Please remit total payment in one currency, U.S. dollar or euro.
(043) Information Technology (116) Public Relations
PMI is an individual membership organization. All membership fees are
(051) International Development (119) Research/Product nonrefundable, nontransferable and subject to change.
(014) Legal Development
(015) Printing/Publishing (056) Retail
(016) Public Administration/ (128) Service & Outsourcing CANADIAN TAX INFORMATION
Government (123) Teaching/Training In accordance with Canadian tax law, PMI collects taxes on member dues, application fees,
(017) Real Estate/Insurance (146) Web Strategist/Technologist and the following Canadian chapters: Canada’s Technology Triangle (CTT); Canadian West
(018) Recreation (125) Other_________________ 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
Return Completed Form with Payment to:
the space provided. The rate of tax and the total amount that you owe will vary depending on
Project Management Institute, 14 Campus Boulevard the province where you have permanent residency. Tax calculations by province are 13% for
Newtown Square, Pennsylvania 19073-3299 USA New Brunswick, Newfoundland, Nova Scotia; 12.88% for Quebec; 5% for all other provinces. If
Or fax to: 1 610 819 0746 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
EMEA Applicants Return Completed Form with Euro or U.S. Dollar Payment to:
need to mail or fax your membership application along with a tax-exempt certification meeting the
Project Management Institute, EMEA Service Centre specifications of the Canadian government.
300, Avenue de Tervueren B-1150 Brussels, Belgium
Or fax to: +32 2 743 15 50 • 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