CIMC

MEMBERSHIP APPLICATION

FORM

“Building capacity of members, creating value for clients, developing competitive advantages”

APPLICANT
CHAPTER INVOLVEMENT
AREAS of PREFERRED PRACTICE

APPLICANT

Title

Mr Ms Dr Other

Gender

Male Female

Surname *

Given Names *

Company *

Position *

Company Address *

City/Parish

Country *

Postal Code

Company Phone *

Company Fax

Home Address *

City/Parish

Country *

Postal Code

Cell Phone

Home Phone

Other Phone

Skype Address

Email Address *

Other Email Address

Website

Address Correspondence to: *

Company

Home

Number of Management Consultants in your firm

1 2-10 11-25 26+

Date consulting since

As a Management Consultant, do you practice:

Full-time Part-time

CHAPTER INVOLVEMENT

I am interested in opportunities for making presentations in my area of expertise

Yes No

I am interested in volunteering time to my local Chapter

Yes No

DEGREE(S) CONFERRED  

Please note: A minimum undergraduate degree or approved equivalent is required for membership.  Please contact CICMC for a list approved university degree equivalencies. 

Institute

Degree/Designations

From Year

To Year

DESIGNATION(S) and other MEMBERSHIPS  

If an area does not apply, please mark with “N/A"

Association / Institute

Designation Earned

From Year

To Year

CONSULTING and OTHER BUSINESS EXPERIENCE  

Please attach a current CV.

Name and Address of Employer / Client

Nature of Business

Name and Address of Employer / Client

Position/ Role

Position/Role

From Month/Year

To Month/Year

AREAS of PREFERRED PRACTICE

Please indicate the areas in which you currently specialize or have an interest.

Operations / Process Improvement

Human Resources Management

Strategy

Business Advisory Services

Information Technology

Marketing

Financial Services

Other – Please specify:

Other

MEMBERSHIP LEVEL

I am seeking membership in CICMC at following level: (select one):

Professional Associate Student

PROFESSIONAL REFERENCES

Please submit along with this application, two (2) letters of reference from past or current clients, or persons who are familiar with your work. The references must pertain to work conducted within the last three years.

Letter of Reference

APPLICATION FEE

A non-refundable Application Fee of US$50.00 is to be submitted with this application form.

Please pay Application Fee HERE

How will you be paying for Application? *

Online Wire Transfer Other

MEMBERSHIP FEES

Annual membership fees are

US$ 250.00 / Barbadian $ 500.00(Professional),
US$ 175.00 / Barbadian $ 350.00 (Associate) and
US$ 100.00 / Barbadian $ 200.00 (Student).

Methods of payment are: credit card through the E-store Here, cash, certified cheque, money order or bank draft.
Make payable to: Caribbean Institute of Certified Management Consultants Inc.

CICMC Membership is on an individual basis. All membership fees are non-refundable and non-transferable

DECLARATION

I hereby declare that I have read CICMC’s Code of Ethics, understand it, and agree to abide by it. I understand that membership in CICMC is conditional upon me successfully completing the Online Ethics course within nine (9) months of my membership confirmation.

Application must be completed in full in order to be processed.

I hereby declare that I have read Privacy Policy, understand it, and agree to it.

Please select *

Code of Ethics

Please select *

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