Membership Application
Preferred Mailing Address: ❑ Home ❑ Business Industry: ❑ Mr. ❑ Ms. ❑ Mrs. ❑ Dr. ❑ Male ❑ Female Date of Birth
M
OFFICE USE ONLY PRIORITY CODE Order Number Member Number
MBKCJ72
/
D
/
Y
❑ Healthcare ❑ Service ❑ Government ❑ Education ❑ Manufacturing
Member Type: ❑ Full Rs. 8,580/- ❑ Associate Rs. 5,100/Rs.
2
Last Name/Family Name
The one geographic Section included with Full membership will be determined by your prim ar y address.* Sections (geographic) may be added to any member type for an additional Rs.1,200/- each. Visit www.asq.org for a listing of available Sections. Sections
, , `
First Name
Middle Initial
Company Name
Job Title
Contact ASQ to change your assigned Section.
Business Address
Ste.
3
Countr y
City, State/Province
Zip+4/Postal Code
Forum or Division Selection As part of your Full membership you receive participation in one topic- or industr y-specific Forum or Division. Use the list below to indicate the Forum or Division number and name.
` (#) Name included
Home Address
Apt./Ste.
Additional Forums and Divisions may be added to all levels of membershi p.
Countr y
City, State/Province
Zip+4/Postal Code
Please indicate in the list below the additional Forums or Divisions you would like and total the number you have selected. ❑ Audit (19) ❑ Automotive (3) ❑ Aviation, Space and Defense(2) ❑ Biomedical (10) ❑ Chemical and Process Industries (4) ❑ Customer-Supplier (15) ❑ Design and Construction (20) ❑ Education (21) ❑ Electronics and Communications (5) ❑ Energy and Environmental (11) ❑ Food, Drug, and Cosmetic (7) ❑ Government (22) ❑ Healthcare (18) ❑ Human Development and Leadership (13) ❑ Inspection (9) ❑ Lean Enterprise (23) ❑ Measurement Quality (17) ❑ Product Safety and Liability Prevention (25) ❑ Quality Management (1) ❑ Reliability (8) ❑ Ser vice Quality (16) ❑ Six Sigma (26) ❑ Software (14) ❑ Statistics (12) ❑ Team & Workplace Exc ellence (27)
Area Code/Business Telephone
Area Code/Home Telephone
Preferred Email Address
Fax
W hich one of the following best describes your title? ❑ Accountant ❑ Administrator ❑ Advisor ❑ Analyst ❑ Associate ❑ Auditor ❑ CEO ❑ Chemist ❑ Cli nician ❑ Consultant ❑ Contractor ❑ Controller/ Comptroller ❑ Coordinator ❑ Di rector ❑ Engineer ❑ Facilitator ❑ Foreman ❑ General ❑ Manager ❑ Inspector ❑ Instructor ❑ Machinist ❑ Manager ❑ Mechanic ❑ Nurse ❑ Owner ❑ Physician ❑ President ❑ Principal ❑ Professor ❑ Programmer ❑ Retired ❑ Scientist ❑ Six Sigma Black Belt ❑ Six Sigma Green Belt ❑ Specialist ❑ Statistician ❑ Student ❑ Superintendent ❑ Teacher ❑ Technician ❑ Unemployed ❑ Other
Additional Forum and Division selections: Full or Associate member x Rs600/- = `
total
Total of all items (1-3):
ASQ does not sell email addresses to third parties. Mailing Lists ❑ Occasionally ASQ shares its mailing list with carefully selected quality-related organizations to provide you with i nformation on products and services. Please check this circle if you do not wish to receive these mailings.
`
Payment Information
❑
Member Referred By:
Cheque or DD Payable to American Society for Quality India Pvt. Ltd.
For bank transfer through NEFT/RTGS: bank details given bellow
Member Name
Member Number
WHY DID YOU JOIN ?
To help us understand what’s important to you, please tell us the top three reasons why you became an ASQ member. ❑ Career Development ❑ Knowledge/Information ❑ Certification Pricing ❑ In-person Networking ❑ Involvement in ASQ’s Cause ❑ Involvement in SRO ❑ Leadership Opportunities
Account Holder Name: AMERICAN SOCIETY FOR QUALITY INDIA PVT. LTD. Current Account Number: 31459090888 IFSC/RTGS code (Indian Financial Security code): SBIN0003219 MICR code: 110002117 Branch Address: State Bank Of India, M-2 South Extension Part-2, New Delhi-110049 Please submit your application with remittance to:
American Society for Quality India Pvt. Ltd.
❑ Online etworking/ Communities ❑ Product Discounts ❑ Training
325, 3rd Floor, DLF Tower B, Jasola District centre, New Delhi – 110025 T.: +91 11 46783399 F: +91 11 40793573 E:
[email protected]
You may also join online at http://asq.org.in and www.asq.org
New memberships are effective upon receipt of payment. New members receive one year of membership from the date they join. Members are billed prior to the anniversary date of their membership for next year’s dues. Memberships, even those paid by employers, are nontransferable. All prices are subject to change. In becoming an ASQ member, you have the duty to follow the ASQ Code of Ethics and Society governing documents.
Item B0357
Resources to Make a Difference in Your Career and Life
ASQ Individual Membership
ASQ, the world’s leading community of people passionate about quality, provides its valued members with the people, ideas, and tools that make our world work better. Get member discounts on the resources you need to set yourself apart from others and show your commitment to your career and organization while investing in the ideas to help meet tomorrow’s critical challenges. Fill out the application on the reverse side and raise the voice of quality.
TYPE OF
MEMBERSHIP
Associate Full
Price Description
Rs.5,100/Use this electronic membership for virtual knowledge exchange and online networking opportunities. benefits and voti ng rights within the Society.
Rs.8,580/- Get complete access to ASQ member
Advanced Membership: Senior and Fellow memberships (8,580/-) require specific professional and member criteria.
PROFESSIONAL EVELOPMENT
Enhance your quality learning to prepare yourself for future employment and receive a wide variety of professional development tools.
BENEFIT
Training Discounts Certification Discounts ASQ Career Center Learning Paths Leadership Opportunities
Description
Find classroom- and Web-based courses on topics such as basic quality and leadership. Make an impression on a future employer by becoming a Certified Quality Improvement Associate or Certified Six Sigma Green Belt. Post your résumé, find a job in engi neering or science, and get inter view tips. Create a personalized path to achieve professional development and educational goals. You must be a Full, Senior, or Fellow member to hold a leadership position in ASQ .
Associate
Full
• •
•
• • • • •
KNOWLEDGE
Learn classic and current quality principles and theories to help you understand how quality can help solve problems, big or small.
BENEFIT
Quality Body of Knowledge (QBOK®) ASQ Weekly and Other E-newsletters Quality Progress ASQ Publications, Journals, and Standards Quality News Today
Description
Find thousands of articles, case studies, hot topics, and more on www.asq.org. Keep up-to-date on the latest quality-related news and editorial content. Get informational case studies, practical advice, and in-depth articles in ASQ’s flagship publication. Learn from quality experts in industries such as manufacturing, service, healthcare, and education. Quality News Today news ser vice provides you with news from around the world and is delivered to you daily.
Associate
Full
• •
PDF
• •
Print
• •
• •
NETWORKING
You have the opportunity to meet, communicate, and collaborate with other quality experts to build your personal network and share knowledge and advice.
BENEFIT
Conference Discounts ASQ Sections ASQ Forums and Divisions Social Media Online Communities
Description
Meet and learn from experts from around the world. Share ideas and best practices with your peers in your local community. Discuss industr y-related hot topics within industr y-specific communities. Communicate 24/7 by following ASQ on Facebook, Twitter, LinkedIn, and YouTube. Foster professional connections by creating your own profile, network, or blog.
Associate
Full
•
• •
• • • • •
Follow us on Facebook, Twitter, LinkedIn, and YouTube.
asq.org.in/membership/index.apsx