Formulario de Inscripción BICSI ENG
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Formulario de Inscripción BICSI ENG

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    Formulario de Inscripción BICSI ENG Formulario de Inscripción BICSI ENG Document Transcript

    • BICSI Individual Membership ApplicationReturn completed form via mail to BICSI, 8610 Hidden River Parkway, Tampa, FL 33637-1000 USA or fax to +1 813.971.4311.You may also apply online at www.bicsi.org/membership. Tel: +1 813.979.1991 or 800.242.7405 (USA and Canada toll-free); Email: bicsi@bicsi.orgLast name First name Middle initial Job titleMember/Customer number (if applicable) How did you hear about BICSI? Company name Company websiteBusiness address Street or P.O. box City State/Province Zip/Postal code CountryHome address Street or P.O. box Apartment number City State/Province Zip/Postal code CountryDaytime phone Cell phone Fax EmailWhere do you prefer to have your mail sent?  Business  Home  not disclose my name. By selecting this option, your name will not appear on the BICSI Web member database. DoAbout You Which subcategory most closely describes your current primary job description? (Choose one)What is your education level? Construction Consultant  Industry Associations  in a Corporate IT Work School or Equivalent High  Technician/Installer  Staff of a Codes Body/ On Department Professional Engineer  2-Year Degree Audio Visual Integrator  Organization  for Local Exchange Carriers Work Undergraduate Degree Education & Training Providers  Staff of a Standards Body/ On Member or Civilian Staff of the  Building Systems Integrator  Graduate Degree  Staff at CEC/Exam Training On Organization Military Electrical Contractor  Partner  Staff of a Trade Group On  for a Network Service Work General Contractor and/or   Staff at an Authorized Training On Construction Manager Provider Facility ITS ConsumersAbout Your Company Security Contractor   Facility Manager Security Manager  Number of employees  Staff at CEC/Training Provider On Project Manager  Partner  Staff of a Wireless Operator On(include all sites): Campus Network Operator   Contractor ITS Member of Faculty at a College/   Staff at a CATV/Broadband On © Copyright BICSI, December 2011. All rights reserved. BICSI and RCDD are registered trademarks of BICSI, Inc. 1-24 Supply Chain Mechanical Contractor  University Service Provider  for an ITS Distributor Work 25-49  Estate Developer Real Member of Faculty at a High   Staff at a CLEC/BLEC On  for an ITS Manufacturer Work 50-99 School  Center Manager Data Manufacturer’s Representative  100-499 Design BICSI Master Instructor   for the Government in an Work  for an ITS Testing Lab Work 500-999  Designer Member of Faculty at a Trade  ITS Capacity 1,000 or more Architect  SchoolType of Membership (See reverse for membership explanations and pricing.) Country will be verified and dues may be amended accordingly. Renewal  New member ($20 additional processing fee)* *Charged only in countries noted on reverse.Please check membership and term desired and fill in membership fee based on country of residence (see reverse). Discounts are provided for multiple-year Note: Membership fees are subject to changeIndividual Memberships. For Associate memberships, multiply annual fee by number of years for which you are applying. without notice. Memberships are based on a 12-month cycle and end on the last day of theIndividual Associate** (Student, Active Military, Retiree, Installer, Technician) Payment of membership dues concurs month joined, in the year the term expires.  1 year $  1 year $ ** Documentation required (see reverse). adherence to the BICSI Articles of U.S. tax matters: Dues are not deductible Note: Installers and Technicians holding Incorporation, Bylaws and other rules as a charitable contribution, but may be deducted  2years $  2years $ the RCDD credential do not qualify for and regulations duly established by the as a business expense. Memberships are  3 years $  3 years $ this level of membership. BICSI Board of Directors. nonrefundable. Payment Internal Use OnlyPlease make all checks payable to BICSI in U.S. dollars, drawn from a U.S. bank. (Call BICSI’s Accounting Department for instructions on wiring funds.) For yourprotection, BICSI does not accept emailed credit card numbers. If paying by credit card, please mail or fax your payment information instead.Total to be paid  Check or Money Order Enclosed$   Visa   MasterCard   American Express    Diner’s Club    Discover    Cardholder name (as the name appears on the credit card) Cardholder signatureCredit card number Expiration date Card billing zip code (required)
    • Individual Membership PricingThe number next to each country corresponds with one of the numbered tables below. Use this systemto determine the cost for the BICSI membership in your country. All prices are listed in U.S. dollars.Membership Options (Visit www.bicsi.org for a full list of membership benefits.)Individual membership is held in the name of the individual and is nontransferable. Discounted rates are available for multi-year memberships.Associate membership is a discounted Individual Membership for full-time students, active-duty military, retired individuals, Installers and Technicians. (Note: Installersand Technicians holding the RCDD® credential do not qualify for this level of membership.) Documentation must be provided as follows: n Students: Full-time students must submit a photocopy of a student ID card and a copy of a current transcript or course schedule. n  Active-duty military personnel: Must submit a copy of their orders, military ID card. n  Retired individuals: Must be age 62 or older and submit proof of age, as well as a letter stating that he or she is retired. Proof of age may be any valid form of ID   that indicates name and year born. The letter must be written by the member or past employer and must be signed. Algeria 2 Egypt 2 Pakistan 2 Europe, Japan and South Pacific Residents Please contact your district affiliate, listed below, for membership Angola 2 El Salvador 3 Panama 3 information and pricing. Antigua 3 Ethiopia 2 Paraguay 3 Europe Japan Argentina 3 Ghana 2 Peru 3 Avenue de Tervueren, 300 BICSI Japan District Manager Aruba 3 Guatemala 3 Philippines 3 B-1150 Brussels, Belgium Kazuo Kato Tel: +32 2 789 2333 23-19-501 MitsukechouBritish West Indies 3 Guyana 3 Puerto Rico 3 Fax: +32 2 743 1550 Hiratsuka Bahamas 3 Haiti 3 Qatar 3 Email: bicsieurope@bicsi.org Kanagawa 254-0045 Japan Bahrain 3 Honduras 3 Saudi Arabia 3 Web: www.bicsi.org/europe Tel: +81 3-463-74-6030 Email: bicsikato@nifty.com Bangladesh 3 Hong Kong 3 Singapore 3 Web: www.bicsi-japan.org Barbados 3 India 2 South Africa 2 Benin 2 Indonesia 3 South Korea 3 South Pacific Belize 3 Israel *1 Sri Lanka 2 (includes Australia, Fiji, Guam, New Zealand, North Mariana Bermuda 3 Jamaica 3 St. Lucia 3 Islands and Papua New Guinea) Bhutan 2 Jordan 3 Suriname 3 434 St. Kilda Rd., Suite 111 Bolivia 3 Kazakhstan 3 Taiwan 3 Melbourne, Victoria, Australia 3004 Tel: +61 03 9867 4911 Botswana 2 Kenya 2 Thailand 3 Fax: +61 03 9867 5099 Brazil 3 Kuwait 3 Trinidad/Tobago 3 Email: bicsi@bicsi.com.au Brunei 3 Libya 2 Tunisia 2 Web: www.bicsi.com.au Canada *1 Malaysia 3 Uganda 2 Cayman Islands 1 Maldives 2 U.A.E. 3 Chile 3 Mauritius 2 U.S.A. *1 Table 1 China 3 Mexico 1 U.S. Armed Forces 3 1-year 2-year 3-year Associate $150 $275 $400 $75 Colombia 3 Morocco 2 Uruguay 3 Costa Rica 3 Nepal 3 Venezuela 3 Table 2 Curaçao 3 Netherlands Antilles 2 Virgin Islands 3 1-year 2-year 3-year Associate Dominica 3 Nicaragua 3 Yemen 3 $100 $175 $250 $50 Dominican Rep. 3 Nigeria 2 Zambia 2 Ecuador 3 Oman 3 Table 3 1-year 2-year 3-year Associate*$20 processing fee applied to NEW memberships in designated countries (based on residence). $70 $115 $160 $50
    • BICSI Corporate Membership ApplicationReturn completed form via mail to BICSI, 8610 Hidden River Parkway, Tampa, FL 33637-1000 USA or fax to +1 813.971.4311.You may also apply online at www.bicsi.org/membership. Tel: +1 813.979.1991 or 800.242.7405 (USA and Canada toll-free); Email: bicsi@bicsi.orgLast name First name Middle initial Job titleMember/Customer number (if applicable) How did you hear about BICSI? Company name Company website Email addressBusiness address Street or P.O. box City State/Province Zip/Postal code Country Phone Fax New Member (Add $20 processing fee if applicable, only in countries noted on reverse).   Do not list my company in the Corporate Buyers Guide.   Do not list my company or employees on BICSI’s website.Which subcategory most closely describes your current primary job description? (Choose one)Construction Design Member of Faculty at a College/  ITS Consumers Member or Civilian Staff of the   Technician/Installer  Designer University  Facility Manager Military Audio Visual Integrator  Architect Member of Faculty at a High School   Campus Network Operator  for a Network Service Work Building Systems Integrator  Consultant  Master Instructor BICSI  Staff at a CATV/Broadband On Provider Electrical Contractor  Professional Engineer Member of Faculty at a Trade  Service Provider Security Manager   General Contractor and/or School  Staff at a CLEC/BLEC On  Staff of a Wireless Operator On Education & Training Providers Construction Manager Industry Associations  Center Manager Data Supply Chain  Staff at CEC/Exam Training On Security Contractor Partner  Staff of a Codes Body/ On  for the Government in an Work  for an ITS Distributor Work Project Manager Organization ITS Capacity  for an ITS Manufacturer Work  Staff at an Authorized Training On Contractor ITS Facility  Staff of a Standards Body/ On  in a Corporate IT Department Work  Manufacturer’s Representative Mechanical Contractor  Staff at CEC/Training Provider On Organization  for Local Exchange Carriers Work  for an ITS Testing Lab Work Estate Developer Real Partner  Staff of a Trade Group OnCheck the corporate membership level and term you are purchasing and fill in membership fee based on country of residence (see reverse). Basic  1 year $    2 Level  1 year $  4 Level  1 year $  5 Level 1 year $   2 years $    2 years $    2 years $   2 years $   3 years $    3 years $    3 years $   3 years $   Indicate who will be receiving the membership. Indicate who will be receiving the memberships Indicate who will be receiving the memberships Indicate who will be receiving the memberships (three total; two are transferable). (seven total; four are transferable). (10 total; six are transferable). 1 (Main contact*) 1 1 1 (Main contact*) (Main contact*) (Main contact*) 2 2 2 (Transferable) 3 3 3 (Transferable) 4 4  1 Level 1 year $   (Transferable) 2 years $    3 Level  1 year $ 5 5 3 years $   (Transferable) (Transferable)  2 years $   Indicate who will be receiving the memberships  3 years $   6 6 (two total; one is transferable). (Transferable) (Transferable) Indicate who will be receiving the memberships (five total; three are transferable). 7 7 1 (Transferable) (Transferable) (Main contact*) 1 8 2 (Main contact*) (Transferable) (Transferable) 2 9 (Transferable) 3 10 (Transferable) (Transferable) 4 (Transferable) * Only the main contact is necessary to complete the application. Other members may be identified at a later date. Note: Membership fees are subject to change U.S. tax matters: Dues are not deductible as a 5 (Transferable) without notice. Memberships are based on a 12- charitable contribution, but may be deducted as a month cycle and end on the last day of the month business expense. Memberships are nonrefundable. joined, in the year the term expires.Payment Internal Use OnlyPlease make all checks payable to BICSI in U.S. dollars, drawn from a U.S. bank. (Call BICSI’s Accounting Department for instructions on wiring funds.) For yourprotection, BICSI does not accept emailed credit card numbers. If paying by credit card, please mail or fax your payment information instead.Total to be paid  Check or Money Order Enclosed$  Visa    MasterCard    American Express    Diner’s Club    DiscoverCardholder name (as the name appears on the credit card) Cardholder signatureCredit card number Expiration date Card billing zip code (required)
    • Corporate Connection Program PricingThe number next to each country corresponds with one of the numbered tables below.Use this system to determine the cost for the program in your country. All prices are listed in U.S. dollars. Algeria 2 Kazakhstan 3 Europe, Japan and South Pacific Residents Angola 3 Kenya 3 Please contact your district affiliate, listed below, for membership information and pricing. Antigua 3 Kuwait 3 Europe Japan South Pacific Argentina 3 Libya 2 Avenue de Tervueren, 300 BICSI Japan District Manager (includes Australia, Fiji, Guam, Aruba 3 Malaysia 3 B-1150 Brussels, Belgium Kazuo Kato New Zealand, North Mariana British West Indies 3 Maldives 2 Tel: +32 2 789 2333 23-19-501 Mitsukechou Islands and Papua New Guinea) Bahamas 3 Mauritius 2 Fax: +32 2 743 1550 Hiratsuka 434 St. Kilda Rd., Suite 111 Email: bicsieurope@bicsi.org Kanagawa 254-0045 Japan Melbourne, Victoria, Australia 3004 Bahrain 3 Mexico 1 Web: www.bicsi.org/europe Tel: +81 3-463-74-6030 Tel: +61 03 9867 4911 Bangladesh 3 Morocco 2 Email: bicsikato@nifty.com Fax: +61 03 9867 5099 Barbados 3 Nepal 3 Web: www.bicsi-japan.org Email: bicsi@bicsi.com.au Benin 2 Netherlands Antilles 2 Web: www.bicsi.com.au Belize 3 Nicaragua 3 Bermuda 3 Nigeria 2 Table 1 Bhutan 2 Oman 3 Basic 2-year 3-year $300 $600 $900 Bolivia 3 Pakistan 2 Level 1 2-year 3-year Botswana 2 Panama 3 $425 $800 $1,150 Brazil 3 Paraguay 3 Level 2 2-year 3-year Brunei 3 Peru 3 $1,000 $1,900 $2,700 Level 3 2-year 3-year Canada *1 Philippines 3 $2,000 $3,700 $5,400 Cayman Islands 1 Puerto Rico 3 Level 4 2-year 3-year Chile 3 Qatar 3 $5,000 $9,500 $14,000 Level 5 2-year 3-year China 3 Saudi Arabia 3 $8,000 $15,000 $21,000 Colombia 3 Singapore 3 Table 2 Costa Rica 3 South Africa 2 Basic 2-year 3-year © Copyright BICSI, December 2011. All rights reserved. BICSI and RCDD are registered trademarks of BICSI, Inc. Curaçao 3 South Korea 3 $200 $400 $600 Dominica 3 Sri Lanka 2 Level 1 2-year 3-year Dominican Rep. 3 St. Lucia 3 $325 $600 $1,050 Level 2 2-year 3-year Ecuador 3 Suriname 3 $700 $1,300 $1,800 Egypt 2 Taiwan 3 Level 3 2-year 3-year El Salvador 3 Thailand 3 $1,400 $2,500 $3,600 Level 4 2-year 3-year Ethiopia 2 Trinidad/Tobago 3 $3,800 $7,100 $10,400 Ghana 2 Tunisia 2 Level 5 2-year 3-year Guatemala 3 Uganda 2 $5,600 $10,200 $13,800 Guyana 3 U.A.E. 3 Table 3 Haiti 3 U.S.A. *1 Basic 2-year 3-year $250 $500 $750 Honduras 3 U.S. Armed Forces 3 Level 1 2-year 3-year Hong Kong 3 Uruguay 3 $400 $750 $1,075 India 2 Venezuela 3 Level 2 2-year 3-year Indonesia 3 Virgin Islands 3 $850 $1,600 $2,250 Level 3 2-year 3-year Israel *1 Yemen 3 $1,700 $3,100 $4,500 Jamaica 3 Zambia 2 Level 4 2-year 3-year Jordan 3 $4,100 $7,700 $11,300*$20 processing fee applied to NEW memberships in designated Level 5 2-year 3-yearcountries (based on residence). $6,800 $12,600 $17,400