ISM-Willamette Valley Membership Application

Institute for Supply Management, Inc.
Members are encouraged to join an ISM Affiliated Association. To obtain information on the ISM Affiliated Association closest to you and dues information, please call ISM Customer Service at 800/888-6276 or 480-752-6276, extension 401.

Applications can also be submitted by submitting the form below.

Please check the appropriate box:
New Member   Past Member
I am replacing the following current member in my organization (If replacing a current member, send completed application to the affiliate.)
Member Name: Member ID#:

CPSM   C.P.M.   A.P.P.   Other  
First Name:            MI: Last Name:         
Title (required):   Email (required):

Please check the preferred mailing address:
Business Home
Organization (required):

Business Address:  

City: State: Zip:

Home Address: 

City: State: Zip:
Business Phone Number: () Home Phone Number: ()
Fax Number: ()  

Date of Birth (optional): / /
Industry Code (choose a 3-digit code from the list provided):  
Number of employees at your location (please check one): under 100     100-249     250-499     500-999     1,000+

Education (check highest level completed):
High School     Associates's     Bachelor's     Master's     Other
Institution Name: Graduation Date:

Would you like to serve on a committee? Yes   No 

Are you involved in sales? If so, explain:

MEMBERSHIP TYPE: Please select one of the options below. Click here for option details.

Regular Membership
- Includes ISM and affiliate benefits.
I choose to become a member through (please provide affiliate name):
For dues information and affiliate code, contact ISM Customer Service at 800-888-6276 or 480-752-6276, extension 401.
      Annual ISM/Affiliate Dues: USD - $210.00
      One Time Administrative Fee: USD - $20.00
      Annual ISM/Affiliate Dues with Meeting Attendance: USD - $298.00
            * Includes attendance for all quarterly Professional Development Meetings

Associate Membership

      Annual Associate Dues: USD - $70.00

Student Membership
- no charge.

Method of payment: (U.S. Funds Only):
Personal Check     Organization Check     Credit Card    

ISM members receive Inside Supply Management® magazine as a $24 portion of the membership fee. This fee is non-deductible from membership dues. I agree to abide by the ISM Bylaws, Principles and Standards of Ethical Supply Management Conduct, and Statement of Antitrust Policy, as stated on the back of this application. A copy of the ISM Bylaws may be obtained by writing or calling ISM Customer Service at the address or telephone number listed below.

Signature: Date:

Comments and/or Special Instructions: