OFFICE USE ONLY

Membership Application OIMBR18

ITEM CODE____________________________
Order Number ________________________

Member Number ______________________

Preferred Mailing Address: ❑ Home Industry: ❑ Healthcare

❑ Business ❑ Service Member Type:
❑ Government ❑ Education
1 ❑ Full $159 ❑ Associate $99 $___________________
❑ Mr. ❑ Ms. ❑ Mrs. ❑ Dr. ❑ Male ❑ Female
❑ Manufacturing ❑ Other
/ /
Date of Birth _________________________________ The one geographic Section included with Full membership will be determined
M D Y
2 by your primary address.*

_______________________________________________________________________________________ Sections (geographic) may be added to any member type for an additional $20.00
First Name Middle Initial Last Name/Family Name each. Visit www.asq.org/sections/find.html for a listing of available Sections.

_______________________________________________________________________________________ Sections , , 0.00

$_________________
Company Name Job Title
Contact ASQ to change your assigned Section.

_______________________________________________________________________________________ F orum or Division Selection

Business Address Ste.
3 As part of your Full membership, you are granted access to one topic- or
industry-specific Forum or Division. Use the list below to indicate the Forum
_______________________________________________________________________________________ or Division number and name.
City, State/Province Zip+4/Postal Code Country
included
__________________________________ __________________
Name
_______________________________________________________________________________________
Home Address Apt./Ste.
Additional Forums and Divisions may be added for $10 each.
_______________________________________________________________________________________ Please indicate in the list below the additional Forums or Divisions you
City, State/Province Zip+4/Postal Code Country would like and total the number you have selected.
❑ Audit ❑ Innovation
_______________________________________________________________________________________
Area Code/Business Telephone Area Code/Home Telephone ❑ Automotive ❑ Inspection
❑ Aviation, Space and Defense ❑ Lean Enterprise
_______________________________________________________________________________________ ❑ Biomedical ❑ Measurement Quality
Preferred Email Address Fax ❑ Chemical and Process Industries ❑ Quality Management
❑ Customer-Supplier ❑ Reliability
❑ Design and Construction ❑ Service Quality
Which one of the following best describes your title?
❑ Education ❑ Six Sigma
❑ Accountant ❑ Contractor ❑ Inspector ❑ Professor ❑ Student ❑ Electronics and Communications ❑ Software
❑ Administrator ❑ Controller/ ❑ Instructor ❑ Programmer ❑ Superintendent ❑ Energy and Environmental ❑ Statistics
❑ Advisor Comptroller ❑ Machinist ❑ Retired ❑ Teacher ❑ Food, Drug, and Cosmetic ❑ Team & Workplace Excellence
❑ Analyst ❑ Coordinator ❑ Manager ❑ Scientist ❑ Technician ❑ Government
❑ Associate ❑ Director ❑ Mechanic ❑ Six Sigma ❑ Unemployed ❑ Healthcare
❑ Auditor ❑ Engineer ❑ Nurse Black Belt ❑ Other ❑ Human Development and
❑ CEO ❑ Facilitator ❑ Owner ❑ Six Sigma Leadership
❑ Chemist ❑ Foreman ❑ Physician Green Belt 0 0.00
Additional Forum and Division selections: _______ x $10 = $_______________
❑ Clinician ❑ General ❑ President ❑ Specialist total
❑ Consultant Manager ❑ Principal ❑ Statistician 0.00
TOTAL OF ALL ITEMS (1-3). $

ASQ does not sell email addresses to third parties.

Mailing Lists
Payment Information
❑ Occasionally ASQ shares its mailing list with carefully selected quality-related
❑ Check or money order (U.S. dollars drawn on a U.S. bank) Make check payable to ASQ.
­organizations to provide you with information on products and services. Please
check this circle if you do not wish to receive these mailings.
❑ MasterCard ❑ Visa ❑ American Express   (Check one)
Member Referred By:

___________________________________ __________________________ _______________________________________________________________________________________

Member Name Member Number
WHY DID YOU JOIN?
To help us understand what’s important to you, please tell us the top three
reasons why you became an ASQ member.
❑ Career Development
❑ Certification Pricing
❑ In-person Networking
❑ Involvement in ASQ’s Cause
❑ Involvement in SRO
Cardholder’s Name (please print)
________________________________________________ ____________________________________
Card Number Exp. Date
________________________________________________
Cardholder’s Signature
_______________________________________________________________________________________
Cardholder’s Address
❑ Knowledge/Information
Please submit your application with remittance to:
❑ Leadership Opportunities
ASQ You may also join online at www.asq.org
P.O. Box 3066 or by calling ASQ Customer Care at
❑ O
 nline Networking/ USA and Canada: 800-248-1946
Milwaukee, WI 53201-3066 USA
Communities Mexico: 001-877-442-8726
or fax to 414-272-1734. All other locations: +1-414-272-8575
❑ Product Discounts 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 year’s dues.
❑ Training 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
Print FY18
Resources to Make a Difference in Your Career and Life
ASQ Individual Membership
ASQ, the world’s leading community of people passionate about
TYPE OF Price Description
quality, provides its valued members with the people, ideas, and
tools that make our world work better. Get member discounts on
MEMBERSHIP
Associate Use this electronic membership for virtual
the resources you need to set yourself apart from others and show $99 knowledge exchange and online networking
your commitment to your career and organization while investing opportunities.

in the ideas to help meet tomorrow’s critical challenges. Full Get complete access to ASQ member benefits
$159 and voting rights within the Society.
Fill out the application on the reverse side and raise the voice Advanced Membership: Senior and Fellow memberships ($159) require specific professional and
of quality. member criteria.

PROFESSIONAL DEVELOPMENT
Enhance your quality learning to prepare yourself for future employment and receive a wide variety of professional development tools.

BENEFIT Description Associate Full

Training Discounts Find classroom- and Web-based courses on topics such as basic quality and leadership. • •
Certification Discounts Make an impression on a future employer by becoming a Certified Quality Improvement
• •
Associate or Certified Six Sigma Green Belt.

ASQ Career Center Post your résumé, find a job in engineering or science, and get interview tips. • •
Learning Paths Create a personalized path to achieve professional development and educational goals. •
Leadership Opportunities You must be a Full, Senior, or Fellow member to hold a leadership position in ASQ. •

KNOWLEDGE
Learn classic and current quality principles and theories to help you understand how quality can help solve problems, big or small.

BENEFIT Description Associate Full

Quality Body of Knowledge
Find thousands of articles, case studies, hot topics, and more on www.asq.org. • •
(QBOK®)
ASQ Weekly and Other
Keep up to date on the latest quality-related news and editorial content. • •
E-newsletters
Quality Progress Get informational case studies, practical advice, and in-depth articles in ASQ’s flagship publication. PDF Print

ASQ Publications, Journals,

Learn from quality experts in industries such as manufacturing, service, healthcare, and education. • •
and Standards
Quality News Today Quality News Today news service provides you with news from around the
• •
world and is delivered to you daily.

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 Description Associate Full

Conference Discounts
ASQ Sections
ASQ Forums and Divisions
Social Media
Online Communities
Meet and learn from experts from around the world. • •
Share ideas and best practices with your peers in your local community. •
Discuss industry-related hot topics within industry-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. • •

Follow us on Facebook, Twitter, LinkedIn, and YouTube.

asq.org/membership