ZAMBIA INSTITUTE OF MARKETING

[Established by Act of Parliament No. 14 of 2003]

APPLICATION FOR MEMBERSHIP IMPORTANT INSTRUCTIONS Before completing the attached application form, please read the following instructions very carefully. a) All sections must be completed. Except section VII that is optional. b) A K 50, 000.00 Non-refundable application fee must accompany the application. No application can be considered before this fee is paid in cash, cheque or money order. c) The applicable membership subscription should be paid only after you have been admitted. d) You should include, as part of your application, a self-addressed, stamped envelope, to enable the institute to communicate its decision to you. e) If you want the institute to acknowledge receipt of your application, then send another envelope with specifications in (d.) above. f) All cash and non cash payment s for membership subscriptions and application fees should be made payable to: The Zambia Institute of Marketing (ZIM) physically at the Secretariat in Lusaka or deposited into the Zambia Institute of Marketing Bank Account at Indo Zambia Bank, North End Brach, Lusaka Ac. No. 5010051004. Once a deposit into the account is made the deposit slip must be faxed to ZIM on fax No. 260-1-232604. Photocopies of all academic and professional qualifications and/or transcripts must bear English translations.

REFERENCE The Institute values reference letters that dwell on specifics about the applicant, rather than on generalities. Since this is an important part of your application, select a referee who can give an accurate account of your professional development. Registrar Zambia Institute of Marketing P.O Box 32180 LUSAKA. Email: zim@iconnect.zm MEMBERSHIP APPLICATION FORM All information given in this form will be strictly confidential. Typed written applications are preferred, otherwise use capital letters. SECTION I: PERSONAL DETAILS I. Surname: II. Title: Prof./Dr./Mr./Miss ..Other Names: .

III. Date of Birth

IV. Nationality V. Home Address VI. Telephone

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VII. Business Address VIII. Business Telephone IX. Email: X. Current Job Title

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SECTION II: ACADEMIC QUALIFICATIONS

Using the chart below list all the Secondary Schools, Colleges and Universities you attended in chronological order. Secondary School, College, University Dates Attended From To Certificate, Diploma, Degree Class of Certificate, Diploma, Degree

SECTION III: PROFESSIONAL QUALIFICATIONS

I. In the space provided below, list all your additional professional qualifications attained and institutions attended :

II.) Are you already a member of other professional bodies? Yes . No . If yes, please give details:

SECTION IV: BUSINESS EXPERIENCE

Beginning with current employer, list names of all the companies you have worked for, when, type of company (Service, Manufacturing, Wholesale, Retailing, etc) and positions held. Use the chart given below: Name of Company Type of Company Dates of Employment Position Held From To

SECTION V: TYPE OF MEMBERSHIP SOUGHT

Indicate below, with a tick, the type of membership you are applying for. Please note that the new corresponding membership fees are effective from 10th January, 2007: ZMK 60, 000.00 250, 000.00 300, 000.00 750, 000.00 3

STUDENT MEMBER GRADUATE MEMBER ASSOCIATE MEMBER FULL MEMBER

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FELLOW CORPORATE MEMBER FELLOW RETIRED

1 000 000.00 3, 000, 000.00 300, 000.00

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SECTION VI: REFERENCE

One recommendation letter must accompany this application in a sealed, separate envelope. The letter should be from your employer or someone who has taught you before, preferably at college or University level.

SECTION VII: FURTHER INFORMATION

Applicants are invited to submit, on a separate sheet, any further information they consider relevant to their application, or to expand on replies to questions herein. You may give a brief outline of your objectives in applying for membership in ZIM.

SECTION VIII: OBLIGATION

I agree to accept the decision of the ZIM Registration Committee on grade of membership. If elected, I agree to abide by the rules and regulations set out in the Institute s Professional Code of Conduct. I further agree to remit the appropriate Annual Membership Subscription on demand.

DECLARATION
I hereby declare that the information contained in this application is correct, to the best of my knowledge.

SIGNATURE OF APPLICANT

DATE

ZIM IS A PROFESSIONAL BODY THAT DOES NOT DISCRIMINATE ON THE BASIS OF RACE, CREED, SEX, ETHNIC ORIGIN OR HANDICAP.