ITSMF Thailand Membership Form


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ITSMF Thailand Membership Form

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ITSMF Thailand Membership Form

  1. 1. Membership Application Form Website: Contact: To apply for membership in itSMF Thailand, please complete this form. Mail application form and cheque to: itSMF Thailand Association (TaxID: 3032751322) 2 St. Gabriel’s Foundation Building Thonglor Soi 25, Sukhumvit Soi 55 (Thonglor) Wattana, Bangkok 10110 All cheques to be crossed and made payable to: “itSMF Thailand Association (  ¢¡¤£¦¥¤¡¨§©¢¢ ©¤  ©¡ ©¢ !#%$ ('¢§)10 )” Membership Enquiries: Kh. Viravan Tel: 08-1867-1441 • Fax: 02-736-3903 Membership Category Please tick one of the options below to indicate desired membership category. Category of Membership Annual Membership Fee Student (requires current valid student-ID) THB 1,000.- Individual THB 2,500.- Organization5 THB 15,000.- for up to 5 employees Organization10 THB 25,000.- for up to 10 employees *Note: Please refer to itSMF Thailand website for a full description of membership benefits. Method of Payment All payments are to be made payable to “ITSMF Thailand Association (  ¢¡¤£¦¥¤¡¨§©¢¢ ©¤  ©¡ ©¢ !#%$ ('¢§)10 )”. Please tick payment type from one of the below available options. Payment Type Cheque/Bank Draft No. Bank Amount (THB) Cheque Payment Bank Draft Cash Bank Transfer Bank: Bangkok Bank Branch: Soi Ari Acct.No: 127-4-75727-5 After making the payment through bank teller services (or ATM transfer), please scan in the pay-in form (or ATM slip), and e-mail it to this address Terms and Conditions (1) Payment must be made upon submission of application form. (2) itSMF memberships will not be fully activated until full payment is received. (3) Official receipt will be issued within 10 working days after payment. (4) Members pledge to uphold and abide by itSMF Code of Ethics. (5) itSMF reserves the right to reject any application for membership.
  2. 2. Membership Application Form Website: Contact: Member Information Please complete all requested information below in BLOCK LETTERS (incomplete information may delay the processing of application). Name (Mr. / Ms. / Mrs. / Prof. / Dr.): Company: Position / Title: Office Address: Office Phone: Office E-mail: Mobile Phone: Personal E-mail: Areas of special interest (e.g., Service Desk, Incident, Problem, Availability, etc.): Current Certifications (e.g., ITSM, CISA, CISM, CISSP, CPA, PMP, etc.) *Note: For “Organization” memberships, please fill in one form for each registered employee. Preferences: Share my above provided information with Chapter’s other members. I would like to receive itSMF circular e-mails. Declaration: I, the above named applicant, declare that the information provided on this application form is true and correct to the best of my knowledge. ____________________________ (please sign date here) — For itSMF Use Only — Received by ( date): Membership Approved by ( date): Membership Processed by ( date): Payment Received by ( date): Membership Expiration Date: Membership No.: Remarks: