P.O. Box 719, 31 Adelaide St. E, Toronto, ON M5C 2J8

Application for Individual Membership in the

Toronto Area Chapter of the Society for Information Management

The undersigned hereby applies for membership in the Toronto Area Chapter of the Society for Information Management.

Name: / Job title:
Company: / Department:
# of employees in IT/IS: / # of Staff you manage:
# of Employees in Company:  250 or less  251-500  501-1000  more than 1000
Company Industry (e.g. Banking, Financial/Investment, Insurance, Manufacturing) :

Please complete all fields below but indicate your preferred contact method: Business or Home

Prefer Business Mail or Phone Contact / Prefer Home Mail or Phone Contact
Street address: / Street Address:
City, Province, Postal Code: / City, Province, Postal Code:
Phone: / Phone:
Fax: / Fax:
Prefer Business E-mail Contact / Prefer Home E-mail Contact
Email: / Email:

Please check the category that best describes your role in your organization:

IT Leader – Senior level IT professional in either the public or private sector who:

  • is a director, manager or other leader of a corporate or divisional information systems organization; or
  • holds a management staff position supporting one or more corporate or division information systems heads;

Non-Information Management Executive – holding a senior position in a public or private sector organization whose primary responsibility is not information management;

Consultant – from a service vendor serving information managers;

Academic – holding a position at an accredited university or college

Other – e.g. a leader who holds positions involved in shaping and influencing law and/or government policy involving professional issues of concern to information managers.

Please supply the name and title of an existing SIM Member acting as sponsor:

______

Have you applied to SIM previously? If so, where?
Why are you interested in joining SIM?
How did you hear about SIM?

Applicant agrees that the above information is true to the best of their knowledge and that they have read and will abide by the SIM Code of Conduct.

DATED this ___ day of ______, 20__. ______

(Signature)

METHOD OF PAYMENT: Fees of CAD$600 + HST are calendar year and memberships are non-transferable. Check is enclosed. Make check payable to the "Toronto Area SIM"

Credit Card Payment is also available online: (Click on Membership and Event Registration).

NB: Membership payments will be refunded if membership applications are not approved. Approval of membership application by the Toronto Area SIM Executive Board is required for membership.

SUBMIT THIS REGISTRATION FORM TO:

Attn: Membership Chair

Toronto Area SIM

P.O. Box 719

31 Adelaide St. E

Toronto, ON M5C 2J8

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