SOCIETY FOR INFORMATION MANAGEMENT

Minnesota Chapter

APPLICATION FOR MEMBERSHIP

MEMBER INFORMATION New Member Renewal

MEMBER NAME:
TITLE:
COMPANY NAME:
COMPANY ADDRESS:
CITY, STATE, ZIP:
TELEPHONE:
FAX:
E-MAIL ADDRESS:

MEMBER CLASSIFICATION – (Check One)

$550.00
(voting member)
$400.00
(additional member)
$470.00
(non-profit organization) / Practitioner / A senior information management (IM) professional in a private or public sector organization who is a corporate/division head or a member of an IM management team supporting the corporate/division IM head with key management responsibilities. This category includes:
·  CIOs and CTOs;
·  CIO’s or CTO’s direct reports; and
·  Other IM leaders and managers, whose roles significantly impact the profitability and direction of their company.
$400.00
(voting member)
$400.00
(additional member) / Academic / A full-time university or college faculty member who is making significant contribution to the IM field. An academician who is a recognized scholar and conducts practice-oriented research and/or is a leader in IM curriculum design initiatives. Someone who has reached a senior level in the academic community and has significant influence over the direction of IM education.
$550.00
(voting member)
$400.00
(additional member) / Consultant / A leading expert from a consulting firm who influences the direction of their own company or the direction of their clients’ companies. These individuals must be able to demonstrate that they operate at the senior level and that their responsibilities are primarily in delivering IM services, not selling IM services. Consultants must not engage in marketing at meetings.
$320.00
(voting member) / Member In Transition
Or
Retired Individual / A senior information management (IM) professional in transition or retired who has been a government or corporate/division head or a member of an IM management team supporting the corporate/division IM head with key management responsibilities.

Membership in SIM International is included as a benefit to all chapter members. NOTE: Current SIM International “Enterprise” and “Enterprise Plus” members, please contact SIM Treasurer (over) for billing clarification.

over
APPLICATION FOR MEMBERSHIP - Continued

COMPANY INFORMATION Do NOT include this information in the SIM Directory

Employees (all sites): / Less than 100 / 501 – 1,000 / 5,001 – 10,000
(check one) / 100 – 500 / 1,001 – 5,000 / Greater than 10,000
Annual Revenues: / Less than $50 Million / $101 - $500 Million / $1 Billion - $5 Billion
(check one) / $50 - $100 Million / $501 - $999 Million / Greater than $5 Billion
Primary Industry: / Manufacturing / Retail / Other
(check one) / Financial Services / Government
Services / Academic

SPONSORING SIM MEMBER (for new members only)

MEMBER
NAME:
COMPANY
NAME:

BACKGROUND INFORMATION (for new members only)

PREVIOUS EMPLOYER / JOB TITLE / DATES
EXPLAIN HOW WHAT YOU DO RELATES TO THE MISSION OF SIM:

Background Information will only be used to consider candidates for membership and to introduce

new members to the SIM community.

PAYMENT INFORMATION Please include a copy of this invoice with your payment.

Make check payable to: / Minnesota Chapter of SIM
Send check and copy of invoice to: / Society for Information Management
Minnesota Chapter
5115 Excelsior Blvd #423
St. Louis Park, MN 55416-2906
Tax ID: 41-1396018

As a member of SIM, I agree to abide by the Code of Conduct of the Minnesota Chapter.

SIGNED: / DATE:

FOR CHAPTER USE ONLY

STATUS:
Accepted
Rejected
Deferred / REASON: / DATE:

Rev. 05/05/2012