IIEI MEMBERSHIP APPLICATION
APPLICANT INFORMATION (Print this form using your web-browser's PRINT BUTTON and send it to IIEI.)
Name: ___________________________________________________ Date: ____________
Address: ___________________________________________________________________
City/State/Zip: _______________________________________________________________
Country: ____________________________ Home Phone: (___ )_______________________
Work Phone (____)_____________________ Fax: (____)____________________________
e-mail address: _________________________ Best time to contact________a.m. _______p.m.
ORGANIZATION INFORMATION
Company/School Name:________________________________________________________
Industry/School Major: _____________________________________ SIC Code:___________
Your Company Title:___________________________________________________________
Area of Expertise:_____________________________________________________________
Address:____________________________________________________________________
City/State/Zip: _______________________________________________________________
IIEI ANNUAL MEMBERSHIP DUES INFORMATION
Type of Membership Country Category * Dues Amount
(check one) (Check one only) (Enter Amount)
| [ ] Individual Membership | [ ] A - $55.00 | [ ] B - $35.00 | [ ] C - $28.00 [ ] D - $18.00 | ____________ |
| [ ] Student Membership | [ ] A - $40.00 | [ ] B - $30.00 | [ ] C - $22.00 [ ] D - $15.00 | ______________ |
| [ ] Business Membership | [ ] A - $450.00 | [ ] B- $350.00 | [ ] C - $275.00 [ ] D - $150.00 | ______________ |
* See see a complete listing of all Country Category listings online at www.expandglobal.com or contact an IIEI representative to determine which category your nation has been assigned.
PAYMENT INFORMATION (Note: All dues are payable in U.S. funds only)
| ____ Check Enclosed (payable to International Import-Export Institute.) Outside U.S.A: U.S. Funds Money Order or credit cards listed below.) Charge my credit card: ____ MC _____ Visa ____ AMX ____ Discover Credit Card Account Number: ___________________________________________________ Expiration. Date: _________________ Today's Date __________ Name on card ________________________________________ Signature: ___________________________________________ |
Total Membership Dues Enclosed:
___________ Enter Amount FOR OFFICE USE ONLY Received: _______________ By: ____________________ |
Mail completed form to:
The International Import-Export Institute
11225 N. 28th Dr. Suite B201
Phoenix, AZ 85029 USA
If payment is by Credit Card, you may FAX the completed application, including signature to: (602) 648-5755
Membership Application 2015 Revised 1/17/07