20/F, Two International Finance Centre, 8 Finance Street, Central, Hong Kong
Tel: 3188 1800
Fax: 3188 1808
E-mail: info@cisa-hk.com
MEMBERSHIP APPLICATION FORM
Membership No.________________
FOR OFFICIAL USE ONLY
Application for the membership as □ Individual
□ Corporate
□ Affiliated Member
(Software associations / organizations in China and India can join CISA as Affiliated Members.)
A. Personal Details
(For Corporate Member and Affiliated Member, please provide the details
of contact person)
Name: ____________________________
Surname
Gender: □ Male
□
______________________________
First Name
Female
Address: ____________________________________________________________________________
___________________________________________________
Telephone: ______________________
Mobile: _____________________________
Fax: ____________________________
B. Company / Organization Details
Email: __________________________
(For Individual Member, please provide your company’s
details)
Company / Organization Name: __________________________________________________________
Job Title: ____________________________________________________________________________
Address:
________________________________________________________________________
______________________________________________________
1
Telephone: _______________________
Fax: _______________________________
Website: _________________________
Year of Establishment: _________________
Area of Specialization: ________________________________________________________________
Legal Structure:
□
Private Company
□
□
Government Organization
□
Joint Venture
□
Public Company
Others (Please specify): ____________________________
C. Declaration
I confirm the above information is true.
Signature: _________________________
(with company chop for Corporate / Affiliated Member)
Date: _______________________________
FOR OFFICIAL USE ONLY
Approved by: __________
Date: ___________
2
Remarks: _______________________