Institute for Supply Management Southeast Michigan

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Affiliate Member Application

Employer Information

* Surname

* First Name

Middle Initial

* Last Name

Nickname (for badges)

* Company Name

* Job Title

* Business Address

Internal Mail Code

* City

* State

* Zipcode

* County

* Business E-mail

* Business Phone

Phone Extension

Business Fax

* Are you involved in selling?

home information

Address

Address 2

City

State

Zipcode

County

Personal Email

Home Phone

education

* Education (highest level completed)

* 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?

* Indicate which email address should receive Affiliate communications

Work
Home

* Would you like to serve on a committee?

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

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