2009 Membership Application

Please type or print clearly.

Making project management indispensable for business results

PART 1

Project Management Institute Rio de Janeiro Chapter

By joining PMI, you agree to adhere to the Project Management Institute Code of Ethics and Professional Conduct. The Code can be viewed by visiting www.PMI.org.

Student Membership
FGV

Date

21/10/2011

Project Management Institution

Have you previously been a member of PMI?



No

Yes Year of last membership

Mathaeus

_________

If yes, do you remember your previous ID#?

C. Bastos

____________________________________
SUFFIX

MR.

PREFIX (MR., MRS., MS., DR.)

FIRST NAME (Maximum of 20 letters)

MI

LAST NAME (Maximum of 20 letters)

Mathaeus Bastos PLEASE PRINT NAME AS YOU WANT IT TO APPEAR ON YOUR MEMBERSHIP CERTIFICATE Planejador de Compras Petrobras JOB TITLE COMPANY/ORGANIZATION

Business Address
Avenida Almirante Barroso, 81, 27 Andar, Centro STREET ADDRESS (LINE 1)

STREET ADDRESS (LINE 2) Rio de Janeiro CITY

Rio de Janeiro
STATE/PROVINCE

20031-004
ZIP/ POS TAL C ODE

BRAZIL C OUNTR Y

Home Address
Rua Professor Bilac de Faria, 1745, Cidade Jardim STREET ADDRESS (LINE 1)

STREET ADDRESS (LINE 2) Natal CITY

Rio Grande do Norte

STATE/PROVINCE

59078-370
ZIP/POSTAL CODE

BRAZIL COUNTRY

Contact Information
mathaeuscastro@yahoo.com.br PRIMARY E-MAIL +55 21 3229 7666 mathaeus.bastos@petrobras.com.br SECONDARY E-MAIL

BUSINESS PHONE (WITH COUNTRY CODE, AREA CODE AND EXT.) +55 84 3207 7679 HOME PHONE
(WITH COUNTRY CODE AND AREA CODE)

FAX

(WITH COUNTRY CODE AND AREA CODE)

+55 21 8068 1001

CELLULAR PHONE
(WITH COUNTRY CODE AND AREA CODE)

TOLL-FREE PHONE

By supplying the fax information above, you consent to being contacted by PMI at the fax number provided.

How did you first learn about PMI?

(01) Colleague/Friend, Name?____________________________________________ (02) Employer/Management ___________________________________________ (03) PMI Chapter, Which? ________________________________________________ (04) Other Organization, Which? ________________________________________ (05) Project Management Journal /PM Network /PMI Today (06) Advertising/Publicity, Where? ________________________________________ (07) Conference or Trade Show, Which? ___________________________________ (08) PMI Technical Material, Handbooks, etc. (10) Internet or other Electronic Bulletin Board System, Which?


What is your preferred mailing address?

Home

Business

What is your preferred renewal billing address?

Home Business

If you want to be included in the following, please check each item that applies.
Communications from PMI regarding products, services and events. PMI Dir ectories Third Party Mailing lists

____________________________________________________________________

(11) PMI SIG, Which? ____________________________________________________ (12) Education/Training Program or Course

Specify ____________________________________________________________

(13) PMP Program ______________________________________________________ (14) PMI College, Which? ________________________________________________ (09) Other (please specify) ______________________________________________

After your application is processed, you will receive an e-mail confirmation. Your New Member Welcome folder, including your membership card and membership certificate, A Guide to the Project Management Body of Knowledge (PMBOK Guide) on CD-ROM, and payment receipt will be mailed to you. PM Network and PMI Today will begin arriving in approximately six to eight weeks.
Please Complete Part 2

Membership Application
Your Name

PART 2

DUES INFORMATION: One full year membership (050) Supply Chain (049) Systems Security (019) Telecommunications (020) Transportation (052) Urban Development (021) Utilities (047) Web Technology (022) Other________________
What category best describes your job function?
Engineering

What is your organizations primary business activity (industry)?

Construction

Amounts in U.S. dollar and euro.

U.S. dollar

Dues Calculation
Membership Dues (Enter amount from option 1 or 2 above) Application Fee
(Applies to New and Rejoining Members)

(002) Commercial/Heavy Industrial (001) Residential (003) Other________________

Resources

$ 30.00 $ 10.00

(023) Agriculture (027) Coal/Gas/Oil (025) Ferrous Mining (024) Forestry (026) Non-Ferrous Mining


Component Fees (Visit www.pmi.org for component list and fees.) Rio de Janeiro Chapter PMI Chapter Name __________________________ Total Amount Enclosed $ 20.00 $ 60.00

Manufacturing

(028) Automotive (029) Chemical (030) Concrete/Clay/Glass/Stone (031) Electrical/Electronic (032) Food (033) Machinery/Metals (034) Paper (035) Petroleum (040) Pharmaceutical (036) Plastics (037) Textiles/Fabrics (038) Wood (039) Other________________
Other Business Activities

(157) Chemical (151) Civil (152) Electrical (153) Electronics (154) Environmental (155) Industrial (156) Mechanical (150) Other____________


Do not send cash. Please remit total payment in one currency, U.S. dollar or euro.
PMI is an individual membership organisation. All membership fees are nonrefundable, nontransferable and subject to change.

Management

(045) Academia (004) Aerospace (005) Architecture/Design (006) Arts/Entertainment/ Broadcasting (046) Automation Systems (007) Business Mgmt. Svcs./ Mgmt. Consulting (053) City Management (008) Computers/Software/DP (044) Consulting (009) Defense (048) E-business (010) Economics/Finance (011) Education/Training (041) Engineering (012) Environmental/Waste/ . Sewage (042) Financial Services (013) Health/Human/ Social Services (043) Information Technology (051) International Development (014) Legal (015) Printing/Publishing (016) Public Administration/ Government (017) Real Estate/Insurance (018) Recreation

(102) Communications (149) Configuration (104) Contract/Procurement (101) Corporate/Administrative (105) Cost (148) Critical Chain (147) Earned Value (108) Human Resources (109) Information/Computer (112) Materials (114) Project/Program (117) Quality (118) Records (120) Risk/Safety (121) Scope/Technical (122) Site/Facility (124) Time Mgmt/Scheduling/
Planning

Other

(103) Consulting (106) Distribution (107) Finance (127) Financial Services (110) Legal (111) Marketing/Business Development/Sales (113) Production (115) Project Accounting/Audit (116) Public Relations (119) Research/Product Development (056) Retail (128) Service & Outsourcing (123) Teaching/Training (146) Web Strategist/Technologist (125) Other_________________

Return Completed Form to: PMIRIO - Rio de Janeiro Chapter Av Franklin Roosevelt, 194 Grupo 304 Centro - Rio de Janeiro - CEP 20021-120 Or e-mail to: pmirio@pmirio.org.br

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