Membership Application

Membership Class Information

Member:

Anyone who has an approved bachelor's degree and five years of full-time applicable experience in management of technology (MOT). Academic experience may be substituted in part for work experience up to a total of four years, depending on the degree and major.

Associate:

Anyone who is active in the MOT field but who does not qualify for Member status

Student:

A full time undergraduate or graduate student

1. In section A, check the membership class you are requesting, then complete the other sections listed for that class.
2. Obtain endorsement(s), if required. Submit the completed form with the appropriate dues indicated in Section F. Your form will be submitted toThe Department of Industrial Eng, University of Miami, P.O Box 248294, Coral Gables, Florida 33124-0623, USA

Should you want to speak directly to an IAMOT representative, please call 305-284-4100, Fax 305-284-4040, or by E-mail iamot@miami.edu. Your comments and questions are certainly welcome.

(A)

Membership Class
Check Class Requested:	Member	Associate	Student
Complete Sections:	All sections except E	All sections except E	Sections A, B, E, F, G

(B)

Personal Data
To which address should mail be sent?		Home Work/School
Name	Mr. Mrs. Ms. Dr. First Name Middle Initial Last Name
Home Address	Number and Street/P.O. Box Apt#		Home Phone Area Code Number
	City State/Province Zip/Postal Code Country
Work or School Address	Title Department
	Company or School Name/Division		Work Phone Area Code Number
	Number and Street/P.O.Box		Ext.
	City State/Province Zip/Postal Code Country
	Fax Area Code Number	E-mail Address

(C)

Professional Experience
Start with your most recent experience:
Job Title:	Description:
Organization:
Location:
From - To (Mo./Yr.):
Job Title:	Description:
Organization:
Location:
From - To (Mo./Yr.):
Job Title:	Description:
Organization:
Location:
From - To (Mo./Yr.):

(D)

Academic Background
Degree	Year	Major/Minor	Name, Location of University or College	From Mo./Yr.	To Mo./Yr.

(E)

Endorsement for Students
Endorsement by a Faculty Member or School Official
Endorser's Name Mailing Address

(F)

Fees
Check the appropriate box. (All funds in US dollars)	Members or Associate Members $50 Annual Dues	Student Members $25 Annual Dues
Method of Payment: Cheque Bill Me Credit Card (we will contact you.)

(G)

Agreement: I hereby submit this application and any necessary support documentation for evaluation by the IAMOT Society. I understand that I may not be accepted in the membership class I have requested, but that I can resubmit my application for reclassification if I desire. Agree Not Agree

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