Strategic Management Forum

STRATEGIC MANAGEMENT FORUM

INSTITUTIONAL/ PROFESSIONAL INDIVIDUAL(PI) MEMBERSHIP

1. Category Applied for	: Patron
	PI Life Member
	PI Annual Member
2. Name (in capital letter only)	:_________________________________________________________
3. Father’s/Husband’s Name (PI only	:_________________________________________________________
4. Organization: Name & Address	:_________________________________________________________
	__________________________________________________________
	__________________________________________________________
	__________________________________________________________
5. Home Address (PI only)	:_________________________________________________________
	__________________________________________________________
	__________________________________________________________
	__________________________________________________________
6. Telephone	:Off: _____________________ Res: ____________________________ Fax :_____________________Email____________________________
7. Date of Birth (PI)/ Incorporation (for Institutional Members)	: Day_____________ Month ________________Year _____________
8. Age as on Date	:Years_____________________________________________________
9. Preferred Mailing Address	Home ’ Office ’
10. Experience (PI) in academics/ Executive cadres as on date (No. of years)	:________________________________________________________
11. Professional Experience (PI)

From	To	Designation	Organization and Job Details

12. Membership of other Professional Bodies

________________________________________________

13. Declaration of the applicant

I declare that the statements made throughout this application are correct to the best of my knowledge and belief and that I agree to be governed by the bye-laws of the SMF as they now exist and hereafter if they be altered. I further undertake that I will promote the objectives of the SMF and contribute to the best of my abilities for furthering strategic Management movement in the country. If at any time, I fail to comply with the requirements of the SMF with regard to the membership, I hereby undertake to return the Certificate of Membership and forfeit the privileges associated with this membership. I also undertake to abide by the SMF Code for Professional Managers’ that the Forum may frame from time to time.

Date: __________________________

Applicant’s Signature _____________________________________

Payment particulars$ (To be filled by applicant)

Draft No. _____________________________________ Amount Rs. ________________________________

Issuing Bank ___________________________________Date Issue _________________________________

$ Subscription for membership:

Annual Subscription for Professional Individual Membership (July 1, to June 30) is Rs. 500/-. For life membership 10 years subscription is to be paid.
Insitutional membership Rs. 100,000/- one time payment

Tick mark only in the numbered boxes provided against the alternative to each question. This is for the purpose of computerized date processing. Please be sure to complete each item.

1. Age as on date

6. Total experience (In years)

25-30

31-35

36-40

41-50

Above 50

3-5

6-10

11-15

16-20

More than 20

2. Sex	7. Professional Skills Acquired
Male	HRD/Personnel
Female	Marketing/Sales
	Finance
3. Marital Status	Quality Control
Married	Corporate planning
Single	EDP

4. Education Qualifications	8. Type of Organisation
Graduate B.Sc/BA/B.Com	Government
Post Graduate M.Ss/M.com/MA/MBE	Public Sector
Engineers BE/B.Tech	Private Sector
ME/M.Tech/MCA	Defence Service
Management Diploma MBA	Bank & Financial Institutions
PHD or equivalent	Medicine
ACS/ICWA/CA other equivalent	Multinationals
Others (specify)	Small Scale Sector

5. Natural of Business of your Organization	9. Level at which you are currently working
Manufacturing	Jr. Management
Marketing/Sales	Middle Management
Banking Service	Senior Management
Public Utility Services	Top Management
Consultancy	Others (Specify) ________________________
Defence
Others(Specify) ________________________