1. BICSI Individual Membership Application
Return 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.org
Last name First name Middle initial Job title
Member/Customer number (if applicable) How did you hear about BICSI?
Company name Company website
Business address Street or P.O. box
City State/Province Zip/Postal code Country
Home address Street or P.O. box Apartment number
City State/Province Zip/Postal code Country
Daytime phone Cell phone Fax Email
Where 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.
Do
About 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 Consumers
About 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
 School
Type 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 change
Individual 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 the
Individual 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 Only
Please 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 your
protection, 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 signature
Credit card number Expiration date Card billing zip code (required)

2. Individual Membership Pricing
The number next to each country corresponds with one of the numbered tables below. Use this system
to 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: Installers
and 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 Mitsukechou
British 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

3. BICSI Corporate Membership Application
Return 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.org
Last name First name Middle initial Job title
Member/Customer number (if applicable) How did you hear about BICSI?
Company name Company website Email address
Business 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
On
Check 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 Only
Please 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 your
protection, 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 signature
Credit card number Expiration date Card billing zip code (required)

4. Corporate Connection Program Pricing
The 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-year
countries (based on residence). $6,800 $12,600 $17,400