Please complete both sides

STUDENT MEMBERSHIP APPLICATION U.S. Federal I.D. No. 23-7067291

Phone: +1.847.660.5505 • Fax: +1.847.253.1443
www.isaca.org/students Contact Support: https://support.isaca.org/

n MR. n MS. n MRS. n MISS n OTHER _______________ Date___________________________________________

MONTH/DAY/YEAR

Name_______________________________________________________________________________________________________________________________
FIRST MIDDLE LAST/FAMILY

Address at school ___________________________________________________________________________________________________________________

STREET
___________________________________________________________________________________________________________________
CITY STATE/PROVINCE/COUNTRY POSTAL CODE/ZIP

Phone at school _________________________________________

AREA/COUNTRY CODE AND NUMBER

University Name ___________________________________________________________________________________________________________________

Field of study/major of concentration_________________________ Expected date of graduation_____________________________________________

Home address ___________________________________________________________________________________________________________________

STREET
___________________________________________________________________________________________________________________
CITY STATE/PROVINCE/COUNTRY POSTAL CODE/ZIP

Home phone _________________________________________

AREA/COUNTRY CODE AND NUMBER

Email ______________________________________________________________

ISACA requires members to provide certain demographic information to help us understand and better serve our constituents, and to ensure that we
deliver information that is relevant to you.
Send mail to Gender Birth Year _____________
n Home n Male
n School n Female
n Non-binary/ Third gender
Degree Program n Other _____________
n Undergraduate n Prefer not to answer
n Graduate
Verification of Student Status
To become a student member, you must attach one of the following:
– Current university issued class schedule
– Copy of your transcript showing the courses you are taking
– Letter from the College or University stating that you are currently enrolled at the school

NOTE: Both your printed application form and document verifying your student status are required for processing. Please allow 3-5 business
days to obtain the student member rate on exams, conferences or purchases.

All International Association benefits will be provided electronically.

Payment due By applying for membership in ISACA, members agree to hold the Association and
• International dues for students $ 25.00 (US) its chapters, and OneInTech, an ISACA Foundation, and their respective officers,
• Chapter dues #____ (see following page) $ (US) directors, members, trustees, employees and agents, harmless for all acts or
PLEASE PAY THIS TOTAL* $ (US) failures to act while carrying out the purposes of the Association and the
* Membership dues consist of international dues and chapter dues. Foundation as set forth in their respective bylaws, and they certify that they will
Membership dues are non-refundable and non-transferable. abide by the Association’s Code of Professional Ethics (www.isaca.org/ethics).
Full payment entitles new members to membership from the date payment is
Mail your application and check to: processed by International Headquarters through 31 December 2021. No rebate of
ISACA • 1055 Paysphere Circle • Chicago, IL 60674 • USA dues is available upon early resignation of membership.
Contributions, dues or gifts to the Information Systems Audit and Control Association
are not tax deductible as charitable contributions in the United States. However, they
Method of payment may be tax deductible as ordinary and necessary business expenses.
n Check payable to “ISACA” in US dollars, drawn on US bank Your contact information will be used to fulfill your request to become an ISACA
n MasterCard n VISA n American Express n Diners Club n Discover member, and may also be used by ISACA to send you information about related
All payments by credit card will be processed in US dollars ISACA goods and services, and other information in which we believe you may be
Credit Card # _______________________________________________ interested. As an ISACA member, we will be sure to keep you up-to-date on the
latest products and services that are available to our community. By applying for
Print name of cardholder ______________________________________ membership, you confirm the information provided on this form is complete and
Expiration date _____________________________________________ accurate, and you authorize ISACA to contact you at the address and numbers
MONTH/YEAR you have provided, including to provide you with marketing and promotional
communications. You further represent that the information you provided is yours
and is accurate. To learn more about how we use the information you have provided
on this form, please read our Privacy Policy, available at www.isaca.org. Should you
elect to attend one of our events or purchase other ISACA programs or services,
Signature__________________________________________________
information you submit may also be used as described to you at that time.

The dues amounts on this application are valid 1 August 2020 through 31 May 2021.
 US dollar amounts listed below are for local chapter-level student dues. While correct For current chapter-level student dues, or if the amount is not listed below, please
at the time of printing, chapter-level student dues are subject to change without visit the ISACA web site to find contact information for your local chapter at
notice. Please include the appropriate chapter dues amount with your remittance. www.isaca.org/chapters.

Name Number Dues Name Number Dues Name Number Dues Name Number Dues

ASIA EUROPE/AFRICA NORTH AMERICA South Florida 33 $0

Bahrain 208 $0
Dhaka, Bangladesh 207 $0
China Hong Kong 64 $0
Ahmedabad, India 247 $10
Bangalore, India 138 $10
Cochin, India 176 $0
Coimbatore, India 155 $5
Hyderabad, India 164 $0
Kolkata, India 165 $5
Chennai, India 99 $5
Mumbai, India 145 $10
New Delhi, India 140 $5
Pune, India 159 $7
Trivandrum, India 242 $5
Vijayawada, India 200 $0
Baghdad, Iraq 244 $25
Indonesia 123 $0
Fukuoka, Japan 219 $0
Nagoya, Japan 118 $0
Osaka, Japan 103 $0
Tokyo, Japan 89 $0
Amman, Jordan 246 $0
Nur-Sultan, Kazakhstan 240 $0
Korea 107 $10
Lebanon 181 $0
Macao 190 $5
Malaysia 93 $0
Muscat, Oman 168 $0
Islamabad, Pakistan 224 $10
Karachi, Pakistan 148 $25
Lahore, Pakistan 196 $10
Manila, Philippines 136 $0
Jeddah, Saudi Arabia 163 $0
Riyadh, Saudi Arabia 154 $0
Singapore 70 $0
Sri Lanka 141 $5
Taiwan 142 $40
Bangkok, Thailand 109 $0
UAE 150 $0
LATIN AMERICA
Buenos Aires, Argentina 124 $0
LaPaz, Bolivia 173 $15
Belo Horizonte, Brazil 245 $0
Brasília, Brazil 202 $0
Rio de Janeiro, Brazil 203 $0
São Paulo, Brazil 166 $0
Santiago, Chile 135 $0
Bogotá, Colombia 126 $10
Medellín, Colombia 229 $10
Costa Rica 31 $15
Santo Domingo,
Dominican Republic 226 $10
Quito, Ecuador 179 $15
San Salvador, El Salvador 232 $0
Guatemala City, Guatemala 215 $15
Guadalajara, México 201 $15
Mexico City, México 14 $15
Monterrey, México 80 $0
Panamá 94 $10
Asunción, Paraguay 184 $20
Lima, Perú 146 $20
Puerto Rico 86 $15
Montevideo, Uruguay 133 $25
Venezuela 113 $0
Austria 157 $5
Belgium 143 $0
Gaborone, Botswana 228 $10
Sofia, Bulgaria 189 $0
Croatia 170 $0
Cyprus 210 $0
Czech Republic 153 $0
Denmark 96 $10
Cairo, Egypt 230 $0
Estonia 162 $0
Finland 115 $0
Paris, France 75 $0
Germany 104 $25
Accra, Ghana 205 $10
Athens, Greece 134 $0
Budapest, Hungary 125 $0
Ireland 156 $0
Israel 40 $0
Milan, Italy 43 $0
Rome, Italy 178 $25
Venice, Italy 216 $0
Kenya 158 $5
Latvia 139 $20
Lithuania 180 $10
Luxembourg 198 $0
Malta 186 $10
Mauritius 211 $15
Casablanca, Morocco 239 $15
Windhoek, Namibia 238 $25
Netherlands 97 $10
Abuja, Nigeria 185 $5
Ibadan, Nigeria 222 $20
Lagos, Nigeria 149 $0
Port Harcourt, Nigeria 234 $10
Norway 74 $0
Katowice, Poland 220 $0
Warsaw, Poland 218 $0
Lisbon, Portugal 209 $0
Romania 172 $0
Moscow, Russia 167 $0
Rwanda 248 $20
Belgrade, Serbia 236 $0
Slovenia 137 $0
Slovakia 160 $0
South Africa 130 $0
Barcelona, Spain 171 $25
Madrid, Spain 183 $0
Valencia, Spain 182 $0
Sweden 88 $0
Switzerland 116 $0
Tanzania 174 $0
Tunis, Tunisia 225 $10
Ankara, Turkey 217 $0
Istanbul, Turkey 204 $0
Kampala, Uganda 199 $50
Kyiv, Ukraine 206 $0
London, UK 60 $0
Central UK 132 $0
Northern England, UK 111 $0
Scotland, UK 175 $0
Winchester, UK 212 $15
Lusaka, Zambia 223 $25
Harare, Zimbabwe 241 $15
Canada
Calgary, AB 121 $0
Edmonton, AB 131 $25
Vancouver, BC 25 $0
Victoria, BC 100 $0
Winnipeg, MB 72 $0
Atlantic Provinces 105 $0
Ottawa Valley, ON 32 $0
Toronto, ON 21 $0
Montreal, PQ 36 $0
Quebec City, PQ 91 $0
Regina, SK 231 $0
Islands
Bermuda 147 $0
Curacao 227 $0
Kingston, Jamaica 233 $0
Trinidad & Tobago 106 $25
Midwestern United States
Central Indiana 56 $0
(Indianapolis)
Chicago, IL 02 $0
Illini (Springfield, IL) 77 $0
Illowa 169 $10
Iowa (Des Moines) 110 $0
Kentuckiana (Louisville, KY) 37 $0
Detroit, MI 08 $0
Western Michigan 38 $0
Minnesota 07 $0
Omaha, NE 23 $0
Fargo, ND 249 $15
Central Ohio (Columbus) 27 $0
Greater Cincinnati, OH 03 $0
Northeast Ohio (Cleveland) 26 $0
Northwest Ohio 188 $5
Milwaukee, WI 57 $0
Madison, WI 243 $15
Northeastern United States
Greater Hartford, CT 28 $0
Central Maryland 24 $0
(Baltimore)
New England 18 $0
New Jersey 30 $0
Central New York 29 $0
(Syracuse)
Hudson Valley, NY 120 $0
(Albany)
New York Metropolitan 10 $0
Western New York 46 $0
(Buffalo/Rochester)
Harrisburg, PA 45 $0
Philadelphia, PA 06 $0
Pittsburgh, PA 13 $0
Rhode Island 197 $0
Greater Washington, D.C. 05 $0
Southeastern United States
Birmingham, AL 65 $0
Huntsville, AL 221 $0
Central Florida (Orlando) 67 $0
Jacksonville, FL 58 $15
Tallahassee, FL 213 $0
West Florida (Tampa) 41 $0
Atlanta, GA 39 $5
Charlotte, NC 51 $0
Research Triangle 59 $0
(Raleigh, NC)
South Carolina Midlands 54 $0
(Columbia, SC)
Memphis, TN 48 $5
Middle Tennessee 102 $0
(Nashville)
Virginia 22 $0
Southwestern United States
Central Arkansas 82 $30
(Little Rock)
Fayetteville, Arkansas 235 $10
Denver, CO 16 $0
Baton Rouge, LA 85 $0
Greater New Orleans, LA 61 $10
Greater Kansas City, MO 87 $0
Springfield, MO 214 $0
St. Louis, MO 11 $0
New Mexico (Albuquerque) 83 $0
Central Oklahoma (OK City) 49 $0
Tulsa, OK 34 $0
Austin, TX 20 $0
Greater Houston Area, TX 09 $0
North Texas (Dallas) 12 $0
San Antonio/So. Texas 81 $15
Western United States
Anchorage, AK 177 $0
Phoenix, AZ 53 $0
Tucson, AZ 237 $0
Los Angeles, CA 01 $0
Orange County, CA 79 $0
(Anaheim)
Sacramento, CA 76 $35
San Francisco, CA 15 $0
San Diego, CA 19 $0
Silicon Valley, CA 62 $0
(Sunnyvale)
Hawaii (Honolulu) 71 $10
Boise, ID 42 $0
Las Vegas, NV 187 $5
Portland, OR 50 $0
Utah (Salt Lake City) 04 $0
Mt. Rainier, WA (Olympia) 129 $10
Puget Sound, WA (Seattle) 35 $0
OCEANIA
Adelaide, Australia 68 $0
Brisbane, Australia 44 $10
Canberra, Australia 92 $0
Melbourne, Australia 47 $0
Perth, Australia 63 $0
Sydney, Australia 17 $0
Auckland, New Zealand 84 $10
Wellington, New Zealand 73 $0
Papua New Guinea 152 $0