Membership Form

What Membership Type are you applying for?*
Pronoun
Name*
First Middle Last Suffix
Preferred Name
Job Title*
Designations
Email*
Personal Email

For staying in contact if you leave your organization or email convention changes, etc.
Date of Birth
MM slash DD slash YYYY
Previous Organization Name
Current Organization Name*
To Whom Do You Report and what is their title?*
Start date
MM slash DD slash YYYY
Preferred Mailing Address*
Street Address City State / Province / Region ZIP / Postal Code Country
Work Phone
Cell Phone
Assistant Name
First Last
Assistant Email
LinkedIn
Twitter
Facebook
Job Description*
Max. file size: 1 GB.
Job description or a brief statement of your areas of accountability
IT Department Organizational Chart*
Max. file size: 1 GB.
How did you hear about CHIME?*
Already have a points sheet?
Max. file size: 1 GB.
Stay ahead of the application process, add your qualifying points sheet here.
I'd also like to join
- Select All
- AEHIS
- AEHIA
- AEHIT
As a Chime member, you are welcome to join our A-Groups at no additional cost.
Privacy Policy*
- Check here to indicate that you have read and agree to the CHIME privacy policy terms.
Privacy Policy- https://chimecentral.org/privacy-policy/
Questions? Contact Us: Should you have other questions or concerns about these privacy policies, please call us at 734.665.0000 or send us an email to [email protected]