NAPM-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 mark.stipek@napm-willamettevalley.org by submitting the form below, or download printable form and fax to 541-346-4268.

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 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 - $190.00 One Time Administrative Fee: USD - $20.00	Annual ISM/Affiliate Dues with Meeting Attendance: USD - $350.00 * Includes attendance for all monthly Professional Development Meetings
ASSOCIATE MEMBERSHIP Associate Membership
Annual Associate Dues: USD - $70.00
STUDENT MEMBERSHIP 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: