SIM NJ Membership Application
Introduction
Member Requirements
Candidates for membership should be senior information executives in private or public sector organizations who are Corporate/Division
heads of an I.S. organization responsible for information systems and technology. Candidates who are full-time faculty members in
colleges or universities should be engaged in teaching and/or research activities that are devoted primarily to areas of senior managerial
interest.
Membership Application Process
Your completed application should be emailed to Rich Cigna or Bob DeMarino at the addresses in the bottom of this application. Do not
submit any payment with your application. If your membership is approved, you will be invoiced for your dues.
Dues Schedule
Organization Category
Profit
Not-for-Profit
Member Category
Practitioners
Leaders
Academic
Consultants/Vendors
Enterprise (Price/Person)
RLF Graduates
$380
$190
$380
$190
$380
$190
$380
$190
$360
$180
Free for year of participation and year
after, then follows the schedule above
General Information
Name:
Title:
Business / Organization:
Address:
City / State / Zip:
Business Phone:
Business Fax:
Business Email:
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Business / Organization Information
Business /Organization Type
For Profit
Not-For-Profit
Company size (check one):
$1M - $100M
$101M-$500M
$501M -$1B
Greater than $1B
Describe your company/organizations business.
Select the industry that best describes your business.
Advertising
Chemical / Natural Resources
Education
Executive Recruiting
Financial Services
Foods
Healthcare/Pharma
Other (Please Specify):
Consulting
Manufacturing
Professional Services
Publishing
Retail
Government
Utilities/Telecom
Your role within your Business/Company
What is the name and title of the person to whom you report?
Select the Reporting relationship that best describes you.
CIO
CXO
Direct report to CIO
Direct report to CXO
Other
As an IT Professional, describe the Information Systems function in your company. If possible, indicate approximate annual budget and/or
number of employees involved in this function.
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Describe your current responsibilities and impact on information management in your business/organization.
As a non-IT Professional, describe your role in your business/organization.
Describe how your role impacts the Information Technology function in your business/organization.
Previous Roles
Please list previous business/organization affiliations and your position
Request for Bio
Include a Short Bio (about 8 lines) describing yourself professionally and include Personal Interests. Feel free to add Bio as a separate
attachment to this document. Please note, this Bio will be distributed to the NJ SIM Membership announcing your joining the SIM NJ
community.
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Academic Applicants
List the titles of courses you currently teach. Indicate graduate or undergraduate level.
Describe any relevant research or consulting areas in which you are currently involved.
Consultants & Vendor Applicants
Consultants and vendor applicants should be senior level executives from their organizations whose primary responsibilities should not be
sales and marketing.
As a Vendor/Consultant applicant, I understand that marketing activities or any type of solicitation is strictly forbidden at SIM meetings or
functions and that membership lists should not be used for solicitation
Please read and sign the Vendor Letter of Agreement (Appendix A) and include it in the submission of this application.
Personal Information
Home Address:
City / State / Zip:
Home Phone:
Mobile Phone:
Personal Email:
Where would you prefer that SIM email and correspondence be sent (check one):
Business Address
Home Address
Knowledge of SIM
How did you learn of SIM NJ?
Why do you want to join SIM? Please list your expectations of being a chapter member.
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Please list the names of current SIM New Jersey members who know you and are willing to sponsor your membership application. If you
do not know any current SIM NJ members please also attach a copy of your current resume including your most recent IT responsibilities.
1.
2.
Previous SIM Membership
Describe any past involvement with the Society or its Chapters:
Signature
Applicant Signature (eMail accepted as signature)
Date
Falsification of information on this application may result in termination of membership in SIM NJ.
Your completed application should be emailed to Rich Cigna at rcigna@sptechpartners.com and Bob DeMarino at
bobd@tgshealthcare.com
If you have any questions regarding membership in SIM NJ or the application process please feel free to contact:
Rich at (201) 881-7686 or Bob at (732) 572-9600 x 291, Vice Presidents – Membership, SIM NJ
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SIM NJ Vendor Member Letter of Agreement
Vendor Company Name:
Address:
Dear (Fill in your name):
Your membership application will be considered by the SIM NJ Executive Committee for approval in the near future. A precondition to the
presentation of your application to the Executive Committee is that you provide a signed copy of this letter of agreement. This is a Chapter By-laws
requirement.
Specifically, if you are approved for membership in SIM NJ, you warrant and agree as follows:
 That your primary role is not sales or marketing
 That you are a senior member of your organization which works with senior IT leaders
 You understand that marketing or any other type of solicitation is strictly forbidden at SIM meetings or functions
 That SIM membership lists may not be used for any sort of marketing or solicitation
 That if approved for membership, that your membership may at the discretion of the Executive Committee be terminated should you violate
the Chapter By-laws
This Letter of Agreement may be executed manually, by facsimile or via PDF.
__________________________
Signature
__________________________
Printed Name and Title
__________________________
Date
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