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American Marketing Association INTERNATIONAL Membership Application Form SLIM Membership No.: ............................... Category: ............................... Authorization: ............................... Receipt No.: ............................... Role Marketer Market Researcher Academic Name Prefix First Middle initial Last Male Female Primary Address Home Address Work Address Employer/Institution Title Street City Postal Code State/Province Country Primary Contact Information Phone: Home Cell Work Country Code City Code Number Extension Email Communication Preferences Do not publish my information in the Membership Directory. Do not send email notifications from AMA (Unless otherwise specified, the above information will be published in the directory.) Interest / Responsibilities (select up to 4) Academia Advertising Analytics / Metrics Brand / Product Management Consumer Products / Packaged Goods Customer Engagement Database / CRM Direct Marketing Email Marketing Event Management / Marketing Global Marketing Green Marketing Higher Education Marketing Marketing Communications Marketing Research Media Planning / Buying Merchandising / Retail Nonprofit Marketing Online / Interactive Marketing Packaging / POP Product Management / Development Professional Development Professional Services Promotion Marketing Public Relations Sales / Sales Management Shopper Insights Social Media Strategy / Planning Statement of Ethics (required; print form and sign) As an AMA member, I agree to abide by the AMA Statement of Ethics, embracing the highest ethical norms and values for marketers. (1) Marketers must first do no harm. (2) Marketers must foster trust in the marketing system. (3) Marketers should embrace, communicate and practice the fundamental ethical values that will improve consumer confidence in the integrity of the marketing exchange system. Any AMA member found to be in violation of the Statement of Ethics may have his or her Association membership suspended or revoked. A complete copy of the AMA Statement of Ethics is available online at MarketingPower.com. In order to validate your application, please sign the Statement of Ethics. I subscribe to the Statement of Ethics and will adhere to it: Signature______________________________________________ Date _____________ 0312 Page 1 continued » American Marketing Association INTERNATIONAL Membership Application Form Membership Dues Annual Membership Dues Country (required) Sri Lanka Amount US$ 100 (discounted rate) Base Membership Dues 2 Years » 10% DISCOUNT 1 Year Membership Dues with complementary online publication 3 Years » 15% DISCOUNT Membership Dues Subtotal US$ For Academic Applicants Only Consumer Behavior Interorganizational Marketing Research Services Marketing Diversity and Marketing Marketing and Entrepreneurship Marketing Strategy Doctoral Students Marketing and Society Relationship Marketing Sports and Special Events Marketing Global Marketing Marketing Communications Retailing and Retail Management Teaching and Learning Innovation, Technology and Interactivity Marketing for Higher Education Selling and Sales Management Special Interest Groups (SIGs) (for academic applicants only; select 1 SIG to be included with your membership) Additional Special Interest Groups One SIG is included in your membership. You may join additional SIGs for US$20 each/year. Multiply the number of additional SIGs by US$20 Then multiply that by the number of years in your membership package = US$ Publications Complimentary: In addition to Marketing News, one publication of your choice is included in your membership. Please select one. Additional Publications: You may also subscribe to additional electronic publications at the discounted rates below. *If you prefer to have your publications in print and mailed to you, add the international postage fee to each publication. Publications by Pricing Tier Complementary Journal of Marketing (Bimonthly) Journal of Marketing Research (Bimonthly) Journal of International Marketing (Quarterly) Journal of Public Policy & Marketing (Semiannually) Marketing Management magazine (Quarterly) Marketing Research magazine (Quarterly) Marketing Health Services magazine (Quarterly) Additional Tier 1 $80 $80 $75 $75 $80 $75 $75 Int’l Postage* +$10 +$10 +$10 +$10 +$5 +$5 +$5 $ $ $ $ $ $ $ Publications Subtotal (if applicable) $ Additional Publications Total (if applicable) $ *Additional fees charged for print publications. Multiply Subtotal by number of years in your membership package Tier 2 / 3 $50 $50 $50 $50 $50 $50 $50 Payment Information (print form and complete this section) Membership Dues $ + Academic SIGs $ Promo Code: + Additional Publications $ (if applicable) Cheque Credit Card: Card Number Signature = Total Payment $ (if applicable) American Express MasterCard 3-Digit Security Code ________________________________________________ Date (mm/dd/yyyy) Return Your Completed Form with Payment to: Sri Lanka Institute of Marketing • No 94, Ananda Rajakaruna Mw, Colombo 10 • Tel: 0112 675 000 Email: [email protected] • Fax: 0112 681 660 • www.slim.lk 0312 Page 2 Visa Exp. Date (mm/yyyy) C