Membership Application

Preferred Mailing Address: Home Business Industry: Mr. Ms. Mrs. Dr. Male Female Date of Birth
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OFFICE USE ONLY PRIORITY CODE Order Number Member Number

MBKCJ72

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D

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Healthcare Service Government Education Manufacturing

Member Type: Full Rs. 8,580/- Associate Rs. 5,100/Rs.

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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
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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 whats 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 ASQs 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: asqindia@asq.org

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 years 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 worlds 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 tomorrows 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 rsum, 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 ASQs 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