Membership Application



STUDENT MEMBERSHIP APPLICATION

Last Name: ________________________________ First Name: __________________ Mr. Mrs. Ms.

Address:_______________________________________________________________

City: _____________________________________ Province:____________________ Postal Code:______________

Home Tel: (____) _____________ Fax: (____)_______________

E-mail Address: ______________________________________________________________

|Membership Fees |AMOUNT |

|Provincial Society: (See Section A) _____________________________ |__________ |

| | |

|GST & HST to fee (Registration # R121813741) | |

Payment by cheque, Visa, MasterCard or American Express MUST accompany this application.

Visa Amex MasterCard Card Number: ______________________________ Expiry Date: _______

_____________________________________________________________________________________________

Privacy Options (See Section D)

• “I agree that my personal contact information may be included in the CIPS Members-Only On-line Directory, which is available only

to CIPS members.” Yes No

• “I agree that my personal contact information may be made available to 3rd parties providing services of interest to Information

Technology (IT) professionals.” Yes No

Student Membership (All applicants for student membership MUST complete this section.)

Type of program: ___________________________ Program Length: 1yr / 2 terms 2 yrs 3 yrs 4 yrs

Expected graduation date __________________ Educational Institute _______________________________

Student Number: ________________________________

“I hereby certify that I am registered full-time in a recognized educational institution, public or commercial, that offers a minimum of two full semesters or approximately 400 hours with a significant computing content (Commercial programs must be accredited by the provincial government to be eligible). I also understand that CIPS may at any time contact my school for verification purposes.”

“I hereby affirm that I subscribe to the purposes of CIPS and adhere to the Code of Ethics (see: cips.ca).

I also understand that my membership is not transferable and non-refundable.”

Signature: Date:

Section A Fee – Includes GST/HST.

| | | | |

|Provincial Society |Student Fee |Provincial Society |Student Fee |

| | | | |

|British Columbia |FREE |New Brunswick |FREE |

|Alberta |FREE |Nova Scotia |FREE |

|Saskatchewan |FREE |PEI |$28.50 |

|Manitoba |FREE |Newfoundland & Labrador |FREE |

|Ontario |FREE | | |

• Note 1: International Applicants - Non residents of Canada must also join a Provincial Society. If you were a former resident of Canada please join the Provincial Society for which you last lived in before leaving Canada. If you have never lived in Canada please select a Provincial Society of your choice.

o Provincial Society of Choice: ___________________________

Section B Professional Certification

In today’s competitive workplace, being certified as an Information Systems Professional of Canada (I.S.P.) is just the edge you need to gain an advantage. An “I.S.P.” after your name tells prospective clients and employers that you have achieved high standards of competency and ethical behavior in the planning, analysis, design, implementation and procurement of information systems. Visit: cips.ca/isp.

CIPS also offers a pre-certification membership privilege to individuals who have met the educational requirements, but who have not yet attained the required years of experience. For more information about becoming a “Candidate member”, visit: cips.ca/candidate.

Section C CIPS Privacy Statement

CIPS collects personal information for the use by staff and member volunteers to:

1) Distribute societal information; 5) Process authorized payments;

2) Promote programs, services and member benefits; 6) Facilitate networking;

3) Solicit member views; 7) Harness member expertise.

4) Analyze demographic information on members;

CIPS distributes mailing information to authorized business partners providing member benefits at the time a member subscribes for a particular service. In the event that membership is not renewed, all information is retained for three years and then archived for demographic analysis by staff and volunteers. All members have access to their personal information through the On-line Membership Directory where they can make corrections directly. Members must verify their identity with a user I.D. and password provided to the member upon joining.

Members may also obtain their information directly from the CIPS National office or via fax. A valid membership card must be produced to obtain this information. On site requests will be answered immediately; all other requests will be answered as soon as possible. All fax requests will be confirmed via the member’s telephone number on file.

CIPS makes its mailing list available only to third parties who provide services or conduct research that is of interest to IT professionals and the IT industry. Each request for use of the CIPS mailing list is evaluated by the CIPS executive on a one-time-use-only basis.

CIPS does not sell or rent its list and does not gain any financial benefit from making the list available.

Section E CIPS Membership Directory: Acceptable Use Policy

CIPS member contact information is for CIPS members' personal use only. As stated in CIPS's Acceptable Use Policy found on the CIPS website, “The directory is for personal use only. Members are not [permitted] to use the directory for commercial purposes.” CIPS members found to be using the CIPS Membership Directory improperly will have their CIPS membership revoked.

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