Professional Documents
Culture Documents
23-7067291
Phone: +1.847.660.5600 Fax: +1.847.253.1652
www.isaca.org
membership@isaca.org
ACADEMIC ADVOCATE
MEMBERSHIP APPLICATION
MR.
MS.
Name_______________________________________________________________________________________________________
FIRST
MIDDLE
LAST/FAMILY
University Name _____________________________________________________________________________________________
University Address _____________________________________________________________________________________________
STREET
_____________________________________________________________________________________________
CITY
STATE/PROVINCE/COUNTRY
POSTAL CODE/ZIP
University phone ____________________________________ University Facsimile ______________________________________
AREA/COUNTRY/CITY CODE AND NUMBER
AREA/COUNTRY/CITY CODE AND NUMBER
Home address
_____________________________________________________________________________________________
STREET
_____________________________________________________________________________________________
CITY
STATE/PROVINCE/COUNTRY
Home phone
_____________________________________
AREA/COUNTRY/CITY CODE AND NUMBER
________________________________________________________
Send mail to
Home
University
Certifications obtained
(other than CISM, CISA, CGEIT, CRISC)
1 CPA
2 CA
3 CIA
4 CBA
5 CCP
6 CSP
7 FCA
8 CFE
9 MA
10 FCPA
11 CFSA
12 CISSP
99 Other ________
Payment due
ISACA Chapter
ISACA Event
ISACA Journal
Do not remember
Email
ocial Media
S
Tradeshow/Seminar
Web Advertisement
Web Site Reference
Other
1
2
3
4
5
6
No experience
1-3 years
4-7 years
8-9 years
10-13 years
14 years or more
$WAIVED (US)
$
(US)
$
(US)
___________________________________________________
By applying for membership in ISACA, members agree to hold the
association and its chapters, and the IT Governance Institute, and their
respective officers, directors, members, trustees, employees and agents,
harmless for all acts or failures to act while carrying out the purposes of the
association and the institute as set forth in their respective bylaws, and they
certify that they will abide by the associations code of professional ethics
(www.isaca.org/ethics).
Full payment entitles new members to membership from the date payment
is processed by ISACA International Headquarters through the end of that
year. No rebate of dues is available upon early resignation of membership.
Method of payment
Check payable in US dollars, drawn on US bank
American Express
mployer
E
Friend/Colleague
Postal Mail
Professor/Teacher
Publication
Teaching experience
VISA
MasterCard
POSTAL CODE/ZIP
Diners Club
Discover
Degree program
The university of_______________________________________offers course(s) in: (Check all that apply)
Audit/Accounting/Information Systems
Information Security/Cybersecurity
Enterprise Governance of IT/MIS
IT Risk Management
Qualifications:
ISACA offers complimentary membership for up to two faculty members per functional discipline, such as Audit/Accounting/Information Systems,
Information Security/Cybersecurity, Enterprise Governance of IT/MIS, and IT Risk Management in educational institutions offering degree programs and
executive/Masters programs in Business, Finance, and/or Computer Science.
I certify that I meet the qualifications above to be an ISACA Academic Advocate.
__________________________________________
signature required
Mr.
Ms.
Other:_____________________________ (specify)
Librarian name:_____________________________________________________________________________________________________________
First Middle
Last/Family
Prospective Academic Advocates must verify their status in one of these ways:
1. Attach an Eligibility Letter to the application. The Eligibility Letter on university letterhead should be signed by the head of the department, stating
that the applicant is a full or part-time faculty member, or a recognized adjunct instructor, and verifying the degrees offered by the university in
disciplines covering areas of audit, accounting, information systems, information security, cybersecurity, enterprise governance of IT/MIS and/or IT risk
management.
2. Provide links to the university web site pages, showing the faculty status of the applicant, and verifying the degrees offered by the university in
disciplines covering areas of audit, accounting, information systems, information security, cybersecurity, enterprise governance of IT/MIS and/or IT risk
management.
End of Application-Local Chapter Dues Follow
US dollar amounts listed below are for Academic Advocate local chapter dues.
While correct at the time of printing, chapter dues are subject to change without
notice. Please include the appropriate chapter dues amount with your remittance.
If you have any questions regarding chapter dues, please contact your local
chapter at www.isaca.org/chapters.
Chapter Chapter
Name
Number Dues
Chapter Chapter
Name
Number Dues
Chapter Chapter
Name
Number Dues
Chapter Chapter
Name
Number Dues
ASIA
EUROPE/AFRICA
Edmonton, AB
Vancouver, BC
Victoria, BC
Winnipeg, MB
Atlantic Provinces
Ottawa Valley, ON
Toronto, ON
Montreal, PQ
Quebec City, PQ
Regina, SK
Tallahassee, FL
West Florida (Tampa)
Atlanta, GA
Charlotte, NC
Research Triangle
Bahrain
Dhaka, Bangladesh
China Hong Kong
Bangalore, India
Cochin, India
Coimbatore, India
Hyderabad, India
Kolkata, India
Chennai, India
Mumbai, India
New Delhi, India
Pune, India
Vijayawada, India
Indonesia
Fukuoka, Japan
Nagoya, Japan
Osaka, Japan
Tokyo, Japan
Korea
Lebanon
Macao
Malaysia
Muscat, Oman
Islamabad, Pakistan
Karachi, Pakistan
Lahore, Pakistan
Manila, Philippines
Jeddah, Saudi Arabia
Riyadh, Saudi Arabia
Singapore
Sri Lanka
Taiwan
Bangkok, Thailand
UAE
208
$0
207
$0
64
$0
138 $10
176
$0
155
$0
164
$0
165 $15
99
$0
145
$0
140
$0
159
$0
200
$0
123 $0
219
$0
118
$0
103 $85
89
$0
107
$0
181 $35
190 $0
93 $0
168 $15
224 $10
148
$0
196 $10
136
$0
163
$0
154
$0
70 $0
141
$0
142 $0
109
$0
150 $0
LATIN AMERICA
Austria
Belgium
Gaborone, Botswana
Sofia, Bulgaria
Croatia
Cyprus
Czech Republic
Denmark
Cairo, Egypt
Estonia
Finland
Paris, France
Germany
Accra, Ghana
Athens, Greece
Budapest, Hungary
Ireland
Tel-Aviv, Israel
Milan, Italy
Rome, Italy
Venice, Italy
Kenya
Latvia
Lithuania
Luxembourg
Malta
Mauritius
Netherlands
Abuja, Nigeria
Ibadan, Nigeria
Lagos, Nigeria
Norway
Katowice, Poland
Warsaw, Poland
Lisbon, Portugal
Moscow, Russia
Romania
Slovenia
Slovak Republic
South Africa
Barcelona, Spain
Madrid, Spain
Valencia, Spain
Sweden
Switzerland
Tanzania
Tunis, Tunisia
Ankara, Turkey
Istanbul, Turkey
Kampala, Uganda
Kyiv, Ukraine
London, UK
Central UK
Northern England, UK
Scotland, UK
Winchester, UK
Lusaka, Zambia
157 $0
143
$0
228 $30
189
$0
170 $0
210 $0
153
$0
96 $0
230
$0
162 $25
115 $0
75
$0
104 $0
205 $20
134
$0
125
$0
156 $0
40
$0
43
$0
178 $26
216 $25
158 $20
139 $20
180 $0
198 $60
186 $0
211 $0
97 $0
185
$0
222
$0
149
$0
74 $0
220
$0
218
$0
209
$0
167
$0
172 $0
137 $0
160
$0
130
$0
171
$0
183
$0
182
$0
88 $0
116 $0
174 $50
225
$0
217 $25
204 $40
199 $50
206
$0
60
$0
132
$0
111
$0
175
$0
212 $10
223 $20
NORTH AMERICA
Canada
Calgary, AB
121
$0
131
25
100
72
105
32
21
36
91
231
$0
$0
$0
$0
$0
$0
$0
$0
$45
$0
213
$5
41 $0
39
$5
51
$0
59
$0
(Raleigh, NC)
$0
(Columbia, SC)
Memphis, TN
Middle Tennessee
48
102
$25
$0
(Nashville)
Islands
Bermuda
Curacao
Trinidad & Tobago
147 $0
227 $15
106
$0
$0
(Indianapolis)
Chicago, IL
02
$0
Illini (Springfield, IL)
77 $0
Illowa
169 $0
Iowa (Des Moines)
110 $0
Kentuckiana (Louisville, KY) 37 $0
Detroit, MI
08
$0
Western Michigan
38
$0
(Grand Rapids)
Minnesota (Minneapolis) 07 $0
Omaha, NE
23
$0
Central Ohio (Columbus)
27 $0
Greater Cincinnati, OH
03
$0
Northeast Ohio (Cleveland) 26 $0
Northwest Ohio
188 $30
Kettle Moraine, WI
57
$0
Northeastern United States
Greater Hartford, CT
28
(Southern New England)
Central Maryland
24
$0
$0
(Baltimore)
18
30
29
$0
$15
$0
120
$0
10
46
$0
$0
(Albany)
$0
$0
$0
$0
Sacramento, CA
San Francisco, CA
San Diego, CA
Silicon Valley, CA
76
15
19
62
$0
$0
$0
$0
(Sunnyvale)
Hawaii (Honolulu)
Boise, ID
Las Vegas, NV
Willamette Valley, OR
71 $0
42
$0
187
$0
50
$0
(Portland)
(Syracuse)
Hudson Valley, NY
(Little Rock)
Denver, CO
16
$0
Baton Rouge, LA
85
$0
Greater New Orleans, LA 61 $10
Greater Kansas City, MO 87
$0
Springfield, MO
214
$0
St. Louis, MO
11
$0
New Mexico (Albuquerque) 83 $25
Central Oklahoma (OKCity) 49 $0
Tulsa, OK
34
$0
Austin, TX
20
$0
Greater Houston Area, TX 09 $0
North Texas (Dallas) 12 $0
San Antonio/So. Texas 81
$0
(Anaheim)
(Milwaukee)
New England
New Jersey
Central New York
Virginia
22 $0
Southwestern United States
Central Arkansas
82 $30
(Buffalo/Rochester)
Harrisburg, PA
45
$0
Philadelphia, PA
06
$0
Pittsburgh, PA
13
$0
Rhode Island
197
$0
National Capital Area, DC 05 $0
Southeastern United States
Birmingham, AL
65 $0
Huntsville, AL
221
$0
Central Florida (Orlando) 67 $0
Jacksonville, FL
58
$0
South Florida
33
$0
OCEANIA
Adelaide, Australia
68
$0
Brisbane, Australia
44
$5
Canberra, Australia
92
$0
Melbourne, Australia
47
$0
Perth, Australia
63
$0
Sydney, Australia
17
$0
Auckland, New Zealand
84 $0
Wellington, New Zealand 73 $0
Papua New Guinea
152
$0