Membership Application form - PMI

Membership Application PAGE 1 OF 4

For faster processing, join PMI online using a credit card. By joining PMI, you agree to adhere to the Project Management Institute Code of Ethics and Professional Conduct.

Tips for completing this form: • Hand-write your information clearly in blue or black ink onto a printed form and submit it by postal mail. • Type your information into the PDF. If you have PDF-editing software like Adobe® Acrobat® or Foxit® Reader, you can save your data. Otherwise, you will only be able to type your information, then print out the form and send it to PMI.

Select your membership option

 Individual Membership

 Student Membership

(Students must provide proof of current full time enrollment. Please do not send separately. Student membership enrollments are subject to verification.)

Have you previously been a member of PMI?

 No  Yes

Year of last membership _______________ If yes, what was your previous ID#? ________________________

Preferred language

 Arabic  Japanese

 Chinese  Portuguese

 Dutch  Russian

 English  Spanish

 French  Swedish

 German  Other

 Italian

Contact Information Prefix (Mr., Mrs., Ms., Dr.):

First Name (given name):

Middle Name:

Last Name (family name, surname):

Suffix:

Please print name as you want it to appear on your membership certificate: Job Title:

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):

Home Phone (with country code and area code):

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

BRA-027-2016 (08/16)



Home Address  Preferred mailing address Street Address:

City:

State/Province/Territory:

Country:

Zip/Postal Code:

Business Address  Preferred mailing address Street Address (Business):

Business Name: City:

State/Province/Territory:

Country:

Zip/Postal Code:

Demographics How many years have you been practicing project management? ___________________ Is project management your primary profession?

 Project management is my primary profession  Project management is a service i provide as part of another  Neither of the above. I am simply interested in project management I would like to:

 Receive promotional messages from PMI  Be included in 3rd party postal mailing lists Please note: Digital New Member Kit is available through myPMI.



What is your organization’s primary business activity (industry)? (Check one)

 Accounting and Finance  Aerospace and Defense  Agriculture  Arts, Entertainment and Recreation  Automotive  Business Services  Chemical  Construction  Consulting  Distributor  Education  Energy (gas, electric, oil) and Utilities  Engineering  Financial Services and Insurance  Food and Beverage  Government  Healthcare  Information and Communications Technology  Information Technology  Insurance  Legal  Management of Enterprises  Manufacturing  Media and Publishing  Mining/Iron/Steel  News/Information  Nonprofit  Not Applicable  Other  Pharmaceutical and Biotechnology  Professional, Scientific, and Technical Services  Real Estate and Property Development  Retail and Wholesale  Telecom  Training  Transportation

What category best describes your job function? (Check one)

 Engineering-Chemical Engineering  Engineering-Civil Engineering  Engineering-Electrical Engineering  Engineering-Electronics Engineering  Engineering-Environmental Engineering  Engineering-Industrial Engineering  Engineering-Mechanical Engineering  Engineering-Other Engineering  Management-Communications Management  Management- Configuration Management  Management-Contract/Procurement Mgmt  Management-Corporate/Administrative Mgmt  Management-Cost Management  Management-Critical Chain Management  Management-Earned Value Management  Management-Human Resources Management  Management-Information/Computer Management  Management-Materials Management  Management-Project/Program  Management-Quality Management  Management-Records Management  Management-Risk/Safety Management  Management-Scope/Technical Management  Management-Site/Facility Management  Management-Time Mgmt/Scheduling/Planning  Other Job Functions-Consulting  Other Job Functions-Distribution  Other Job Functions-Finance  Other Job Functions-Financial Services  Other Job Functions-Legal  Other Job Functions-Marketing/Business Devmt/Sales  Other Job Functions-Other  Other Job Functions-Production  Other Job Functions-Project Accounting/Audit  Other Job Functions-Public Relations  Other Job Functions-Research/Product Development  Other Job Functions-Service and Outsourcing  Other Job Functions-Teaching/Training  Other Job Functions-Web Strategist/Technologist


Dues Information: One full year membership Amounts in U.S. dollar and euro.



Option 1 – PMI Individual Membership



Option 2 – PMI Student Membership

PMI Individual Member Dues

U.S. Dollars

$

129.00 $

$

32.00* $

Euros

105.00

PMI Student Member Dues *All applicants must attach verification of current full time enrollment in a degree-granting program. PMI is unable to process student membership applications without verification documentation. Please do not send separately.

26.00*

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

$________ €________

Application Fee (Applies to new and rejoining Individual Memberships. Student Memberships excluded.)

$

10.00 €

10.00

Chapter Fees (Visit PMI.org for chapter list and fees) PMI Chapter Name(s) _______________________________________________________________________________

$________ €________

Optional Air Mail $60.00 / €50.00 (For PMI publication mailing outside North America, not available for Student Membership)

$________ €________

Optional Donation to the PMI Educational Foundation

$________ €________

If applicable, calculate Canadian Tax (see below)

$________ €________

Total Amount Enclosed

$________ €________

Method of Payment

Payment must accompany application. Purchase Orders not accepted. 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:

 Check  MasterCard  Visa  Bank Transfer  American Express  Diners Club  Discover Credit Card #:

Exp. Date: Signature: ________________________________________

Do not send cash. Please remit total payment in one currency, U.S. dollar or euro. For faster processing, join PMI online at PMI.org using a credit card. PMI is an individual membership organization. All membership fees are nonrefundable, nontransferable and subject to change. CANADIAN TAX INFORMATION In accordance with Canadian tax laws, taxes are collected on member dues and application fees relating to PMI and the following chapters: Canada’s Technology Triangle (CTT), Canadian West Coast Chapter, Durham Highlands, Lakeshore, Levis, Manitoba, Montreal, New Brunswick, Newfoundland & Labrador, North Saskatchewan, Northern Alberta, Nova Scotia, Ottawa Valley, Regina/S. Saskatchewan, South Western Ontario, Southern Alberta, Southern Ontario, and Vancouver Island. The rate of tax charged varies depending on the province address you use. Tax rates by province are as follows: 15% for Nova Scotia; 14.975% for Quebec; 14% for Prince Edward Island; 13% for New Brunswick, Newfoundland and Labrador, and Ontario; and 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 online. 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: 89794 4807 RT0001 QST registration: 1202723001 TQ00001 INDIA TAX INFORMATION India Permanent Account Number: AAHCP6606M

Return completed form with US dollar payment to: Project Management Institute, 14 Campus Blvd, Newtown Square, PA 19073-3299 USA Or fax to +1 610 819 0746. ©2015 Project Management Institute, Inc. All rights reserved. “PMI” and the PMI logo are registered marks of Project Management Institute, Inc BRA-127-2015 (06/15)

Membership Application form - PMI

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