Previous  

Please complete the Application Form, then press submit,
or print a copy and mail to address at bottom of page.
Thank You! 

 

Application Type?

First Name: 

Last Name: 

CPM?

Title: 

Agency/Organization:       

Mailing Address: 

City:       State: 

Zip Code: 

Work Phone: 

FAX: 

Email: 

Home Phone:

Cell Phone:

Highest CPM Level Completed:

Certification Obtained From:

Certification Year:

Are you currently a Certified Public Manager®? 

Date Certified: 

Referred By:

Do you want to add a voluntary $5.00 Donation to the Susan G. Komen Foundation? 

-------------------------------------------------

MEMBERSHIP FEE SCHEDULE

  • ASSOCIATE*: $75 Annually (Completion of an Approved Supervisory Training Program or enrollment in CPM Program)

  • MEMBER: $75.00 Annually (CPM status)

  • RETIREE: $20.00 Annually (Reduced dues rate for all retired members who have CPM Status)

Please make checks payable to the Arizona Society of Certified Public Managers® , Inc. (ASCPM).  Membership Applications will not be valid until payment in full is received by the Society.

Please include verification of Supervisory Program or latest CPM course completion, or your CPM Certification with your check if a new member or if requesting a change in status from Associate to Full Member.

Make Checks Payable to:

Arizona Society of Certified Public Managers®, Inc.

Send Checks to:

ASCPM

P. O. Box 33744

Phoenix, AZ  85067-3744 

* - Associate Members may not hold office on the Board of Directors or serve as Academy Delegates.