Membership Enrollment Form

International Society of Automation

Setting the Standard for Automation™ Join or Renew Online:
www.isa.org/joinisa

Additional ways to join or renew:

Mail this form to: ISA, PO Box 12277, Research Triangle Park, NC 27709-0185, USA | Call ISA Customer Service at: +1 919-549-8411 | Email ISA Customer Service at: info@isa.org


1. Member Information Please print clearly.

❏ Mr. ❏ Ms. ❏ Dr. Name: Last/Family __________________________________________________ First/Given_____________________ Middle Initial_______
❏ PE ❏ CSE ❏ CCST® ❏ CAP®
Company ___________________________________________________ Position/Title___________________________________________________________
Correspondence will be sent to this address: ❏ Home Address ❏ Business Address
Mailing Address/PO Box _____________________________________________________________________________________________________________
______________________________________________________________________________________________________________________________
City_______________________________________________________ _State/Province______________________ Postal Code___________________________
Country ___________________________________________________ _ Email Address__________________________________________________________
Telephone ❏ Mobile ❏ Home ❏ Business ____________________________________________
(include area code or country and city code)
Date of Birth _______ /_______ /_______
dd mm yyyy

Have you ever been a member of ISA? ❏ No ❏ Yes Member No. ____________________________
Highest equivalent degree earned: ❏ High school/Secondary ❏ Associate (2-Year) ❏ Bachelor’s/Undergraduate ❏ Master’s/Graduate ❏ Doctorate/Post graduate
Years of industry work experience _________
ISA will assign you to the closest local Section. If you have a Section preference, please list it here:________________________________________________________
Students Required: University Name __________________________________________ Date of expected graduation (dd/mm/yyyy)____________________________

2. Industry and Job Information

Check your standard industry classification (SIC): (choose only one)
❏ 0000 Other ______________________________ ❏ 3400 Valves, Fittings, Fabricated Metal Prods ❏ 4900 Utilities
❏ 1000 Metal Mining ❏ 3500 Industrial Machinery & Equipment, including ❏ 4910 Utilities-Electrical
❏ 1300 Oil & Gas Extraction Computers ❏ 4920 Utilities-Natural Gas
❏ 1700 Construction ❏ 3600 Electronic & Other Electric Equipment ❏ 4930 Utilities-Combo (Nuclear/Foss Fuel, etc)
❏ 2000 Food ❏ 3660 Communications Equipment ❏ 4940 Utilities-Water/Wastewater
❏ 2100 Tobacco Products ❏ 3670 Semiconductors & Electronic Components ❏ 5000 Instrument & Ctrl Apparatus Sales & Svce
❏ 2200 Textiles ❏ 3700 Transportation ❏ 7370 Systems Integration
❏ 2600 Pulp, Paper & Allied Products ❏ 3710 Transportation-Automotive ❏ 8200 Education
❏ 2800 Chemicals ❏ 3720 Transportation-Aircraft ❏ 8710 Engineering Services
❏ 2830 Pharmaceuticals ❏ 3760 Transportation-Aerospace ❏ 8730 Research, Development & Testing
❏ 2900 Petroleum Refining & Related Industries ❏ 3800 Instmtn/Measmnt/Analysis & Ctrl Apparatus ❏ 8740 Management Consulting
❏ 3000 Rubber & Miscellaneous Plastics ❏ 3840 Medical Instrumentation & Systems ❏ 9100 Government
❏ 3200 Stone, Clay, Glass & Concrete Products ❏ 4600 Utilities-Pipelines except Natural Gas
❏ 3300 Primary Metals ❏ 4810 Communications

Check your primary job function: (choose only one)

❏ 1 Product Design Engineering including applied R&D ❏ AP Networking/Communication Systems ❏ K Technical or Engineering Support
❏ 3 Engineering Management ❏ AQ OEM Product/Systems Engineering ❏ M Purchasing/Procurement
❏ 4 Integrator/Re-seller ❏ AS Project Management ❏ N Education
❏ A General or Corporate Management ❏ AT Engineering (Other) ❏ O Marketing or Sales
❏ AB Management Information Systems ❏ AU Student ❏ S Systems Design Engineering
❏ AD Factory Automation Systems ❏ B Control Systems Engineering ❏ R Retired
❏ AG Engineering Consulting ❏ D Production Engineering ❏ S Systems Design Engineering
❏ AH Supply Chain Management ❏ E Plant Engineering, Operations and Maintenance ❏ T Technician-Other
❏ AI Environmental Controls ❏ F Software Engineering ❏ TE Technician-Electrical
❏ AJ Safety Systems Engineering ❏ G Plant Information Systems ❏ TI Technician-Instrumentation/Control
❏ AK Automation Engineering ❏ H Systems Integration ❏ P Other _________________________________
❏ AN Instrument Engineering ❏ I Measurement, Testing, Quality or Stds Engrg
❏ AO Process Engineering ❏ J Research & Development
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 3. Technical Divisions
Select technical divisions (Check all that apply)
❏ Analysis (A) ❏ Construction & Design (K) ❏ Process Measurement & Control (H)
❏ Automatic Controls & Robotics (M) ❏ Education (E) ❏ Pulp & Paper Industries (L)
❏ Automation Project Management & Delivery (W) ❏ Food & Pharmaceutical Industries (R) ❏ Safety & Security (S)
❏ Building Automation Systems (I) ❏ Leak Detection & Repair (C) ❏ Smart Manufacturing & IIOT (F)
❏ Chemical & Petroleum Industries (G) ❏ Mining & Metals Industries (V) ❏ Test Measurement (J)
❏ Communications (D) ❏ Power Industry (O) ❏ Water & Wastewater Industries (X)

4. Membership Dues
Membership Types (Choose one) Multi-year discounts available by joining online

q Membership — 1 year....................................................................................................................................................................... 130 USD _____________

q Student Membership — 1 year............................................................................................................................................................. 10 USD _____________
_____________
❏ Membership in Reduced-dues Countries* — 1 year.............................................................................................................................. 65 USD

*Contact ISA for the current list of countries.

Optional Subscription
❏ ISA Transactions — A publication of the best technical articles in your profession; 6 issues..................................................... 99 USD/year _____________
NOTE: ISA dues include a subscription to InTech for which a nondeductible annual allocation of 9.52 USD is made for members and 0.87 USD for student members.

ENTER TOTAL DUES AMOUNT HERE USD

5. Payment
To make a credit card payment, visit www.isa.org/join to complete the application, or contact info@isa.org.

❏ Check payable to ISA ❏ Money Order ❏ Wire Transfer—Please contact info@isa.org.

ENTER TOTAL AMOUNT DUE HERE USD

6. Signature This application cannot be processed without your signature.

Signature: ________________________________________________________________________ Date: _______________________________

Once you have received confirmation that your membership has been processed, please visit www.isa.org to set up your password and confirm your section
and division selections.

By completing this application, you acknowledge that ISA needs the information to service your membership. Review ISA’s complete Privacy Statement at
www.isa.org/privacy.

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