CIPS+Membership+application by ashrafp

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									                                                             5090 Explorer Drive, suite 801, Mississauga, ON L4W 4T9
                                                             Phone: (905) 602-1370 Fax: (905) 602-7884
                                                             E-mail: info@cips.ca www.cips.ca


                                                   CIPS Membership Application

Last Name:________________________________ First Name: __________________ Mr.                            Mrs.       Ms.      Dr.
Company Name: ___________________________                  Job Title: ___________________________________________
Address:_______________________________________________________________ Home                                          Business
City: _____________________________________ Province:____________________ Postal Code:______________
Business Tel: (____) ________________________              Home Tel: (____) _____________ Fax: (____)_______________
E-mail Address: ______________________________________________________________
Employees of CATA member companies are entitled to 20% discount before taxes
Membership Fees                                                                                               AMOUNT
Fees: (See Section A) _____________________________                                                             __________


Options: (See Section B) ____________________________                                                           __________


GST/HST: All fees should include GST or HST (Registration # R121813741)                                         __________

Total:                                                                                 ________
Payment by cheque, Visa, MasterCard or American Express MUST accompany this application

   Visa         Amex           MasterCard       Card Number: ______________________________                Expiry Date: _______
________________________________________________________________________________________________
Industry Class (Primary business activity at your location)
   Manufacture or Assembly of DP equipment                          Medical and Legal Services          Trade: Wholesale and Retail
   Utilities, Communications, Electric, Gas, Sanitary Services      Government                          Construction
   Computer and Data Processing Services                            Education                           Business / Personal Services
   Agriculture, Forestry, Fishing, Mining and Petroleum             Other Manufacturing                 Other (Please Specify)
   Consulting Engineers and Architects                              Transportation
   Computer Trade: Wholesale and Retail                             Finance, Insurance, and Real Estate


Privacy Options (See Section D)
   I agree that my personal contact information is to be included in the CIPS Members-Only On-line Directory Yes          No
   I agree that my personal contact information may be made available to 3rd parties providing services of interest to information
    technology professionals                                                                                  Yes          No


Professional Certification
In today’s competitive workplace, being certified is just the edge you need to gain an advantage. An “I.S.P.” and/or an “ITCP” after your
name tells prospective clients and employers that you have achieved high standards of competency and ethical behavior.

For details about the I.S.P. and ITCP certifications visit www.cips.ca/certification


I hereby affirm that I subscribe to the purposes of CIPS and adhere to the Code of Ethics and understand that my membership
is NOT transferable and NOT refundable.



Signature:                                                                                       Date:




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Section A          Member Fees - Please add GST Or HST to the fees

              Note: Students must use the Student Application Form available at www.cips.ca/studentsjoin


                        Provincial Society or     Regular Fee      Provincial Society or           Regular Fee
                        Section                                    Section

                        British Columbia                           New Brunswick                   $195.00
                        •Kamloops                 $170.00          Nova Scotia                     $205.00
                        •Klondike                 $180.00          PEI                             $175.00
                        (Whitehorse)
                        •Prince George            $180.00          Newfoundland & Labrador         $200.00
                        •Vancouver                $215.00
                        •Victoria                 $185.00
                        Alberta                   $235.00
                        Saskatchewan              $225.00
                        Manitoba                  $204.21
                        Ontario
                        •Golden Horseshoe         $215.00
                        (Hamilton)
                        •Grand Valley             $205.00
                        (Kitchener/Waterloo)
                        •Kawartha                 $200.00
                        (Peterborough)
                        •London                   $205.00
                        •Ottawa                   $232.24
                        •Toronto                  $245.00

        Note 1: International Applicants - Non residents of Canada must also join a Provincial Society. If you were a former resident of
         Canada please join the Provincial Society for which you last lived in before leaving Canada. If you have never lived in Canada
         please select a Provincial Society of your choice.

              o    Provincial Society of Choice (and section where applicable): _________________


        Note 2: Employees of CATA member companies are entitled to 20% discount before taxes.


        Note 3: Foreign Affiliate membership (20% discount) applies to members NOT residing in Canada of an Affiliated Society
         with whom CIPS has a formal agreement. Please attach a copy of your membership card. (ACM, ACS, IEEE-CS, BCS, NZCS).
         Non residents of Canada must also join a Provincial Society. If you were a former resident of Canada please join the Provincial
         Society for which you last lived in before leaving Canada. If you have never lived in Canada please select a Provincial Society of
         your choice.

              o    Provincial Society of Choice (and section where applicable): _________________



Section B          Options        – Please add GST or HST to the fees


Canadian Human – Computer Communications Society (CH-CCS)             Fees effective March 01, 2008
Purpose: to advance the theory and practice of human computer communications.
Regular Members / Student Members                                                            $60.00. (NS, NB, NL: $60.00)


Canadian Image Processing and Pattern Recognition Society (CIPPRS)
Purpose: to advance the theory and practice of image processing in Canada
Regular Members                                                                                    $28.04 (NS, NB, NL: $28.04)
Student Members                                                                                    $14.01 (NS, NB, NL: $14.01)




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__________________________________________________________________________________________________
Section C         How did you hear/learn about CIPS?
____CIPS Member                                                      ____Web site
____Colleague                                                        ____Presentation/Visit at your company
____Employer                                                         ____Conference/Event
____Word of Mouth                                                    ____Article/Publication
____Advertisement                                                    ____Other (please specify:_______________________)
____Brochure


Referring Member’s Name / Conference or event attended / Article or Publication Name: __________________________________



Section D         CIPS Privacy Statement

CIPS collects personal information for use by staff and member volunteers to:

1) Distribute societal information                                         5) Process authorized payments
2) Promote programs, services and member benefits                          6) Facilitate networking
3) Solicit member views                                                    7) Harness member expertise
4) Analyze demographic information on members

CIPS distributes mailing information to authorized business partners providing member benefits at the time a member
subscribes for a particular service. In the event that membership is not renewed, all information is retained for three years and
then achieved for demographic analysis by staff and volunteers. All members have access to their personal information
through the On-line Membership Directory where they can make corrections directly. Members must verify their identity
with a user ID and password provided to the member upon joining.

Members may also obtain their information directly from the CIPS National office or via fax. A valid membership card must
be produced to obtain this information. On site requests will be answered immediately; all other requests will be answered as
soon as possible. All fax requests will be confirmed via the member’s telephone number on file.

CIPS makes its mailing list available only to third parties who provide services or conduct research that is of interest to IT
professionals and the IT industry. Each request for use of the CIPS mailing list is evaluated by the CIPS executive on a one-
time-use-only basis.

CIPS does not sell or rent its list and does not gain any financial benefits from making the list available.



Section E         CIPS Membership Directory: Acceptable Use Policy

CIPS member contact information is for CIPS members' personal use only. As stated in CIPS's Acceptable Use Policy found
on the CIPS Web site, “The directory is for personal use only. Members are not [permitted] to use the directory for
commercial purposes.” CIPS members found to be using the CIPS Membership Directory improperly will have their CIPS
membership revoked.

CIPS members who would like to propose a special business/commercial offer for consideration as a CIPS member benefit
are asked to send proposals to: info@cips.ca with the subject heading, "CIPS Member Benefit Proposal." CIPS cannot
guarantee the approval of all proposals received. But, we thank all those who submit a business/commercial offer(s) for
CIPS's consideration.




            CIPS – Canada’s Association of Information Technology Professionals


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