AITP

Association of INFORMATION TECHNOLOGY PROFESSIONALS

Professional Membership Application

Please complete all sections of the application. List your G Former Member

(PRINT OR TYPE LEGIBLY) certifications G Former Student Member

G Former Interim Member

Name: First Middle Initial Last

Employer Name: Your Title Dept/Div.

Employer Address: City State/Prov. Zip + 4/Postal

Home Address: City State/Prov. Zip + 4/Postal

Send Mail to: G Home G Company AITP does not sell it’s membership list.

Business Phone: Home Phone: Fax:

E-Mail Address:

Please refer to AITP Dues Reference Guide for Chapter Dues and complete the following, or call the AITP Membership at 800.224.9371 for dues information.

PLEASE NOTE THAT YOU MAY ALSO JOIN ONLINE AT OUR WEBSITE: <WWW.AITP.ORG>

Association Dues: $ 105.00 Specify Chapter Selected: 001 AKRON

Region Dues: $

One time Processing Fee: $ 20.00 Return to: Jacqueline M. Roth

SUB-TOTAL $ 125.00 5080 West Bath Road

Akron, OH 44333-1008

Optional: Phone: (330) 666-6336

Foundation for IT Education $ The Research and Development arm of AITP

EDSIG $ 20.00 AITP’s Education Special Interest Group

SUB-TOTAL $

TOTAL $ Due with this Application. Payment required in U.S. Dollars

Contributions or gifts to the Association of Information Technology Professionals (AITP dues) are not tax deductible as charitable contributions. However, they may be tax deductible as ordinary and necessary business expenses.

Specify Payment Method: G Visa G MasterCard G Check G Money Order

Name on the credit card

Card Number Expiration Date

I hereby apply for membership in AITP. I agree to comply with the requirements of the Bylaws and Code of Ethics and all regulations adopted by the Association of Information Technology Professionals.

Applicant's Signature Date

Sponsor’s Name

(PRINT LEGIBLY)

Association of Information Technology Professionals