DFW Chapter of IACMP – Membership Application

__ Renew (One year from anniversary date)
__ New (For one year from date of processing, allow 3-4 weeks)

Please print carefully. This information will be in the IACMP Website membership database.

Date: ___________________

Name:_______________________________________________________________________________

Title:________________________________________________________________________________

Company Name:______________________________________________________________________

Membership Status (from INDEX page):__________________________________________________

Business Address: ____________________________________________________________________

City: _______________________________ State/Province:_________________ Zip: ______________

Business Phone: ____________________________    Fax: ___________________________________

Residence Phone: ___________________________   

E-mail: _____________________________________________________________________________

Web: http://www._____________________________________________________________________

International Membership - Categories and Dues (in U.S. dollars)

   _____Professional Member = $125. Working in career management profession

   _____Associate Member = $125. Interested but not working in profession

   _____Student/Retired Member = $60

·         [ ] Pay by check to IACMP, 204 E Street N.E. Washington, D.C. 20002

·         [ ] Pay by Credit Card [__] Visa [__] MasterCard

·         Card No._______________________________________

·         Expiration Date: ________________________________

·         Name on Card: _________________________________

·         Signature:_____________________________________ 

Required: (Membership in the IACMP carries the commitment to abide by Standards For Ethical Practice. These standards are contained later on this application.)

ETHICAL PRACTICE PLEDGE: As a member of IACMP, I hereby pledge to uphold the IACMP Standards for Ethical Practice.

·         Signature: _________________________________

·         Date:_____________________________________