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ISM Southeast Michigan Member Directory
Chapter Member Application
Employer Information
Surname
--Please select--
Mr.
Mrs.
Ms.
Dr.
Prof.
*
First Name
Middle Initial
*
Last Name
Nickname (for badges)
*
Company Name
*
Job Title
*
Business Address
Internal Mail Code
*
City
*
State
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
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NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
*
Zipcode
*
County
--Please select--
Wayne
Oakland
Macomb
Livingston
Genesee
St. Clair
Other
*
Business E-mail
*
Business Phone
Phone Extension
Business Fax
*
Are you involved in selling?
--Please select--
No
Yes (Less than 50%)
Yes (More than 50%)
home information
Address
Address 2
City
State
AK
AL
AR
AS
AZ
CA
CO
CT
DC
DE
FL
FM
GA
GU
HI
IA
ID
IL
IN
KS
KY
LA
MA
MD
ME
MH
MI
MN
MO
MP
MS
MT
NC
ND
NE
NH
NJ
NM
NV
NY
OH
OK
OR
PA
PR
PW
RI
SC
SD
TN
TX
UT
VA
VI
VT
WA
WI
WV
WY
Zipcode
County
Personal Email
Home Phone
education
*
Education (highest level completed)
--Please select--
High School
Associate
Bachelors
Masters
Doctorate
Other
*
Institution Name
Graduation Date
additional information and settings
*
Are you an ISM National Member?
Yes
No
If yes, what ISM National membership type do you have?
ISM Corporate Program (through my employer)
ISM Professional (individual membership)
ISM National Membership Number
What ISM National certifications have you completed?
CPM
CPSM
CPSD
CPM, CPSM
CPSM, CPSD
None
*
Indicate which email address should receive ISM Southeast Michigan Chapter communications
Work
Home
*
Would you like to serve on a committee?
--Please select--
Yes
No
Comments and/or Special Instructions
*
Membership Terms
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 is available at www.instituteforsupplymanagement.org.
Yes
