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1625 Prince Street

Alexandria, VA 22314-2818
USA
+1.703.519.6200
Fax: +1.703.519.6298
www.asisonline.org

Application for Membership

Thank you for your interest in ASIS International membership! Please provide the requested information and mail your
completed application and payment to the address shown on the back. Incomplete applications or those submitted without
payment will not be processed. All information provided will be used for internal purposes only.
For faster service, apply online at www.asisonline.org/joinnow.
Membership in ASIS is nonrefundable, individual and is not transferable from one person to another.

Personal Information

First name
Gender:

Middle name
Female

Last name

Male

Non-ASIS security-related certifications (ASIS certifications will be added based on information in our database)

Company name

Business Information

Business address
Job title
City

State/province

ZIP/postal code

Country
Business phone (including country code, area code/city code)

Date employed (month/year)

Home Information

Brief description of security duties and responsibilities

Home address
City

State/province

ZIP/postal code

Country
Home phone (including country code, area code/city code)
Preferred email address (Note: this will be your user name to login to www.asisonline.org)

My preferred mailing address is my :

Home

Business

To which ASIS Chapter do you want to belong? (Note: You will be assigned to a local chapter based on your preferred mailing address unless you indicate otherwise!)
Who may we thank for referring you to ASIS International?
Name

City

Country

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Applicants for Student Membership Only

IMPORT ANT: Only full-time students taking at least nine credit hours in an undergraduate program, or at least six credit hours
in a graduate degree program, are eligible for student membership. Student membership is not available to applicants who are
currently working full-time in security in a supervisory or managerial position.
In order to be considered for student membership, you must attach a copy of your current student identification card, or a
letter from your college or university registrar stating that you are enrolled in a degree program. Applications without an
acceptable identification card or registrar letter will be returned.
Are you enrolled currently as a full-time degree candidate as described above at an accredited college
or university?

Yes

No

How many credit hours are you taking currently?

Expected degree (A.A., B.S., B.A. . . .)

Expected date of graduation

Major

Name of college/university

Location of college/university

Eligibility Information

Membership dues schedule

Have you ever been convicted of a crime (or convicted by a

general court martial in military service)? Yes No
Have you ever had a professional membership, license,
registration, or certification denied, suspended, or revoked
(other than due to a lack of minimum qualifications or failure of
examination)?
Yes No
Have you ever been censured or disciplined by any professional
body or organization?
Yes No
If you answered yes to any of the above three questions, an
explanation on a separate sheet, signed by you, must accompany
your application. This information will not be circulated
outside the ASIS International Board of Directors or its chief
executive officer. Answering yes is not an automatic denial
of membership. Applicant must not have been convicted of any
criminal offense which would reflect negatively on the security
professional and ASIS.

(enter applicable dues in appropriate area)

For applications approved between October 1 through June 30:
$170 USD ($150 annual dues, plus one-time $20 application fee)
Student: $25 USD ($20 annual dues, plus one-time $5 application fee)
For applications approved between July 1 through September 30:
(membership expires on December 31 of the current year)
$95 USD ($75 half-year dues, plus one-time $20 application fee)
Student: $20 USD ($15 annual dues, plus $5 application fee)
All renewals are billed at the annual dues rates of $150 USD; $20 USD for
Students
Note: Membership dues, contributions or gifts to ASIS International are not
deductible as charitable contributions. Your dues payment may be deductible as
an ordinary business expense; however, a percent of your dues is not deductible
as a result of ASIS lobbying activities on behalf of its members. The exact amount
that is nondeductible is disclosed on our website. Please consult with your tax
advisor regarding any tax issues.
Members receive a subscription to Security Management magazine (published
monthly) and the bi-monthly Dynamics e-newsletter as part of their membership
dues. A total of $48 USD is allocated to support these publications.
ASIS FED. ID #53-0234507

ASIS Foundation

Statement and Signature

I certify that all information herein is true and complete to the
best of my knowledge and belief and authorize verification of
this information, and release all concerned from any liability in
connection therewith. I hereby apply for membership in ASIS
International and have read and understand the qualifications of
membership, application fees, and dues payment requirements.
I agree to abide by the ASIS International bylaws and code of
ethics, and agree to promote its objectives. Providing false or
misleading information in this application form or failure to
adhere to ASIS bylaws and code of ethics shall be grounds for
denial of membership or expulsion from ASIS International
whenever discovered.

Signature
Date

Help build your Foundation! The ASIS Foundation conducts education and research
in areas related to the security profession. Your contribution may be tax deductible
and is strictly voluntary. Please consider adding a contribution to your membership
dues today.

Payment Summary
Membership

$ ______________

Foundation ($30 suggested) $ ______________

Total amount paid (U.S. Dollars only) $ ______________

Method of Payment (Please print clearly)

Check enclosed.
All checks must be in U.S. dollars and drawn on a U.S. bank.
There is a $25 returned check charge.
Please charge: MasterCard VISA American Express Discover

Cardholder name

FOR ASIS USE ONLY

MEMBERSHIP #
APPR. DATE
MEMBER TYPE
MAIL IND.
CHAPTER

Questions?
Contact the ASIS Member Services
Center at +1.703.519.6200 or
asis@asisonline.org with any
questions concerning ASIS
membership and application status.

Card number
Expiration date
Authorized amount
Cardholder signature
Mail application and payment to:
ASIS International; P.O. Box 17673; Baltimore, MD 21297-1673 USA
or fax to: +1.703.519.6298
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