APPLICATION FOR GROUP MEMBERSHIP - Society for College ...

Application for Group MembershipToday’s Date: _____________Joining SCUP for the first timeChanging from individual to group membership. SCUP ID(s): _____________Renewing our SCUP group membership. Main Contact’s SCUP ID: _____________Please describe the changes you would like to make to an existing membership, if any:______________________________________________________________________________________________________________________________________________________________________________________________________________________________About Group Memberships:• The membership dues rates on this application are in effect until September 30, 2014. Rates are subject to change everyOctober 1.• Membership begins the month the payment is received for a period of one year, e.g., if your group joins on 3/7/2014, then themembership will expire on 3/31/2015.• The main contact, who is a member of the group, identifies and approves all group members and will receive alldues notices.• The organization itself is not the member. Each group membership is a bundle of individual memberships purchased at thesame time at a reduced rate per person. The individuals listed in the group are the members.• Group memberships are non-refundable; but, unlike regular individual memberships, the bundle of memberships is ownedby the organization that purchased them. The organization retains the membership if one of the members leaves theorganization. Another employee may then fill the retained membership.• All members are assigned to one of five geographic regions: Mid-Atlantic, North Atlantic, North Central, Pacific, or Southern.• Institutions (colleges and universities) with group memberships can register anyone on campus—faculty, staff, and students—for SCUP events at the member rate.1 Main Contact InformationPlease identify a main contact for your group. This member will identify and approve group members and receive the annual duesnotice. Please print or type. Your official job title and organization name should not be abbreviated.Prefix (Mr, Mrs, Ms*):_______ First Name:_______________________________________________ Middle Initial:_____Last Name:_________________________________________________ SCUP ID (if known):__________________Official Job Title (no abbreviation):______________________________________________________________________________________Department/Office/School (no abbreviation):_____________________________________________________________________________Organization (no abbreviation):________________________________________________________________________________________Address (street address—no PO Box):_____________________________________________________________________________________Address (continued):__________________________________________________________________________________________________City:_______________________________________________________________State/Province:_________________________________Zip/Postal Code:_____________________ Country: ______________________________________Phone (country code, if applicable): ________________________________________________________Email:_____________________________________________________________________________Emergency Contact Name: ___________________________________________ Emergency Contact Phone:_____________________* In the spirit of equality, SCUP has chosen not to use “Dr” as a prefix.9/2013 Page 1

2 Tell Us About Your Main ContactPlease help us to understand and serve our members better. The information gathered in these sections will be used to provideyou with personalized information about SCUP benefits and events and will be analyzed only in aggregate.A. What types of planning do you do in your current position, if any? (Check all that apply)Faculty member (research, teaching) Financial planning (budget/fiscal) Residential life planningAcademic planning Institutional research planning Space management planningCampus/master planning IT or technology planning Strategic planningCapital planning Learning spaces planning Student housing planningCommunity relations (town/gown) Open spaces/landscape planning Student services planningEmergency planning Parking/transportation planning Other: ______________________Enrollment management Policy & governance I do not do planning in myFacility planning Recreational facilities planning current position.B. From the list above, what is the ONE planning responsibility that most occupies your time:______________________________________________________________________________________________________________C. What other associations do you belong to? (Check all that apply)AASHE: Association for the AdvancementASLA: American Society of Landscape Architectsof Sustainability in Higher EducationAUA: Association of University ArchitectsAERA: American Educational Research Association EDUCAUSEAIA: American Institute of ArchitectsNACUBO: National Association of College and UniversityAIR: Association for Institutional ResearchBusiness OfficersAPA: American Planning AssociationOther: _________________________________________APPA: Leadership in Educational FacilitiesOther: _________________________________________ASHE: Association for the Study of Higher Education Other: _________________________________________(The answers to the items below will not be published.)D. Birth year:1945 and earlier 1951–1955 1961–1965 1971–1975 1981–19851946–1950 1956–1960 1966–1970 1976–1980 1986 and afterE. GenderMaleFemaleF. Highest educational degree attained:Associate’s Master’s Other: ____________________Bachelor’sDoctorateG. In what discipline is your highest degree?Architecture Higher education administration Urban design or planningBusiness Landscape architecture Other: __________________________Education administrationPublic administrationH. What certifications or licenses requiring continuing education do you presently hold?AICP: American Institute of Certified PlannersOther: _________________________________________Architect’s licenseOther: _________________________________________CPA: Certified Public AccountantOther: _________________________________________Landscape architect’s licenseOther: _________________________________________I. Please indicate the certifying body(ies) for these continuing education units:AIA: American Institute of ArchitectsOther: _________________________________________AICP: American Institute of Certified PlannersOther: _________________________________________ASLA: American Society of Landscape ArchitectsOther: _________________________________________NASBA: National Association of State Boards of AccountancyJ. I have read the SCUP Culture Statement and Guidelines found at www.scup.org/culture:Yes No9/2013 Page 2

3 Contact Information for Group MembersPlease identify the other members of your group. Duplicate this section and complete for each member of the group. Please printor type. Official job title and organization name should not be abbreviated.Prefix (Mr, Mrs, Ms*):_______ First Name:_______________________________________________ Middle Initial:_____Last Name:_________________________________________________ SCUP ID (if known):__________________Official Job Title (no abbreviation):____________________________________________________________________________________Department/Office/School (no abbreviation):____________________________________________________________________________Organization (no abbreviation):_______________________________________________________________________________________Address (street address—no PO Box):___________________________________________________________________________________Address (continued):________________________________________________________________________________________________City:_______________________________________________________________State/Province:_______________________________Zip/Postal Code:_____________________ Country: ______________________________________Phone (country code, if applicable): ________________________________________________________Email:_____________________________________________________________________________* In the spirit of equality, SCUP has chosen not to use “Dr” as a prefix.4 Tell Us About This Group MemberPlease help us to understand and serve our members better. The information gathered in these sections will be used to provideyou with personalized information about SCUP benefits and events and will be analyzed only in aggregate.A. What types of planning do you do in your current position, if any? (Check all that apply)Faculty member (research, teaching) Financial planning (budget/fiscal) Residential life planningAcademic planning Institutional research planning Space management planningCampus/master planning IT or technology planning Strategic planningCapital planning Learning spaces planning Student housing planningCommunity relations (town/gown) Open spaces/landscape planning Student services planningEmergency planning Parking/transportation planning Other: ______________________Enrollment management Policy & governance I do not do planning in myFacility planning Recreational facilities planning current position.B. From the list above, please tell us the ONE planning responsibility that most occupies your time:_____________________________________________________________________________________________________________C. What other associations do you belong to? (Check all that apply)AASHE: Association for the AdvancementASLA: American Society of Landscape Architectsof Sustainability in Higher EducationAUA: Association of University ArchitectsAERA: American Educational Research Association EDUCAUSEAIA: American Institute of ArchitectsNACUBO: National Association of College and UniversityAIR: Association for Institutional ResearchBusiness OfficersAPA: American Planning AssociationOther: _________________________________________APPA: Leadership in Educational FacilitiesOther: _________________________________________ASHE: Association for the Study of Higher Education Other: _________________________________________(The answers to the items below will not be published.)D. Birth year:1945 and earlier 1951–1955 1961–1965 1971–1975 1981–19851946–1950 1956–1960 1966–1970 1976–1980 1986 and afterE. Gender:MaleFemale9/2013 Page 3

F. Highest educational degree attained:Associate’s Master’s Other: ____________________Bachelor’sDoctorateG. In what discipline is your highest degree?Architecture Higher education administration Urban design or planningBusiness Landscape architecture Other: __________________________Education administrationPublic administrationH. What certifications or licenses requiring continuing education do you presently hold?AICP: American Institute of Certified PlannersOther: _________________________________________Architect’s licenseOther: _________________________________________CPA: Certified Public AccountantOther: _________________________________________Landscape architect’s licenseOther: _________________________________________I. Please indicate the certifying body(ies) for these continuing education units:AIA: American Institute of ArchitectsOther: _________________________________________AICP: American Institute of Certified PlannersOther: _________________________________________ASLA: American Society of Landscape ArchitectsOther: _________________________________________NASBA: National Association of State Boards of AccountancyJ. I have read the SCUP Culture Statement and Guidelines found at www.scup.org/culture:Yes NoInstructions for remaining parts:• If you work for a college or university, government agency, accrediting agency, foundation, non-profit, or not-for-profit,complete Parts 5 and 6, Reason for Joining, and Payment Information.• If you work for a for-profit business, complete Parts 7 and 8, Reason for Joining, and Payment Information.5 Institutional Group MembershipsComplete this section ONLY if you work for (1) a postsecondary institution (college and university), or (2) a government agency,foundation, accrediting agency, non-profit, or not-for-profit organization.For U.S. institutions, the society uses the total enrollment figures reported by your institution to the Integrated PostsecondaryEducation Data System (IPEDS) to determine the appropriate institutional group.Select one:INSTITUTIONAL A WITH TOTAL ENROLLMENT OF 1–2,999 $840 USDIncludes membership privileges for three people. “Add on” members are $280 USD each.INSTITUTIONAL B WITH TOTAL ENROLLMENT OF 3,000–5,999 $1,120 USDIncludes membership privileges for four people. “Add on” members are $280 USD each.INSTITUTIONAL C WITH TOTAL ENROLLMENT OF 6,000–11,999 $1,400 USDIncludes membership privileges for five people. “Add on” members are $280 USD each.INSTITUTIONAL D WITH TOTAL ENROLLMENT OF 12,000–17,999 $1,680 USDIncludes membership privileges for six people. “Add on” members are $280 USD each.INSTITUTIONAL E WITH TOTAL ENROLLMENT OF 18,000 AND OVER $1,960 USDIncludes membership privileges for seven people. “Add on” members are $280 USD each.INSTITUTIONAL F COMMUNITY COLLEGE/SYSTEM OFFICE $840 USDIncludes membership privileges for three people. “Add on” members are $280 USD each.INSTITUTIONAL G GOVERNMENT, FOUNDATIONS, ACCREDITING AGENCIES, NON-PROFITS,AND NOT-FOR-PROFIT ORGANIZATIONS $840 USDIncludes membership privileges for three people. “Add on” members are $280 USD each.9/2013 Page 4

6 Tell Us About Your Institution/Agency/Foundation/Non-Profita. I work for a: (Choose one)Higher education institution State government agency Non-profit organizationFederal government agency Foundation Not-for-profit organizationAccrediting agency Systems office For-profit businessGoverning boardLocal government agency7 Corporate Group MembershipsComplete this section ONLY if you work for a for-profit business or consultancy.SMALL CORPORATE GROUP MEMBERSHIP $900 USDIncludes membership privileges for three people. “Add on” members are $300 USD each.LARGE CORPORATE GROUP MEMBERSHIP $1,800 USDIncludes membership privileges for six people. “Add on” members are $300 USD each.8 Tell Us About Your firma. What services does your firm provide? (Check all that apply)Academic Planning Facility Management Life Cycle AnalysisAccessibility Feasibility Studies Lighting DesignAcoustics Financial Planning MaintenanceAdaptive Reuse Food Service/Dining Master PlanningArchitecture Geotechnical Engineering MediaCampus Housing HVAC/Air Quality Parking/TransportationCampus Planning/Design Historic Architecture Parks & RecreationCivil Engineering Historic Cultural Landscape Performing ArtsConstruction Historic Preservation PlanningConstruction Management Interior Design Project ManagementEco-Technologies LEED Certification Services Space ManagementEnergy Planning Laboratories/Healthcare Technology/Information ManagementEngineering Land Planning Wayfinding/Signage/GraphicsEnvironmental Planning Landscape Architecture Other_____________________Estimating/CostingLandscape Designb. What types of buildings/space usage does your firm specialize in, if any? (Check all that apply)Academic Libraries PlazasGardens/Arboreta Museums RecreationGreenways/Trails Office Religious FacilitiesHealth Facilities Parking Research FacilitiesHousing Parks Stadiums/ArenasLaboratories Performing Arts Other_____________________Reason for JoiningA. Please share why your organization has chosen to purchase a group membership with SCUP:___________________________________________________________________________________________________________________B. How did your organization hear about SCUP? (Choose one)Advertisement Planning for Higher Education SCUP websiteAnnual, international conference Postcard The SCUP ScanBook Regional conference/event Trends in Higher EducationBooth SCUP Award WebcastColleague SCUP Member News WorkshopMembership brochure SCUP Planning Institute Other: __________________9/2013 Page 5

Payment Information (FEIN 38-6147432)Total Amount Remitted in USD: $__________________Please choose a payment method (credit card payments are required for international members):1 Check(Check enclosed; make payable to SCUP. Funds must be US dollars and drawn on a US bank.)2 Purchase Order Number: ______________SCUP’s Purchase Order Policy: The society accepts institutional purchase orders for conference registrations, membership dues, and productpurchases. Institutions wishing to pay with a purchase order must fax a copy of the purchase order to the SCUP office at 734.527.6069 or includeit with the mailed registration, order form, or membership application before the order will be processed. Purchase orders are only accepted fromhigher education institutions. All other organizations must pay with a credit card or check.Please send invoice to this email address: ____________________________________________________3 Credit CardCard Number: ______________________________________ Card Expiration Date: _______________CSC (Card Security Code): _______________(The CSC is the 3- or 4-digit code located on the back of MasterCard or Visa cards, and on the front of American Express cards.)Name on Card (Please print): _________________________________Signature: __________________________________________(If filling in form on screen, omit signature.)Please send PDF receipt to this email address: ____________________________________________________You may fill in this application form on screen, save it, and email it to Member Services at membership@scup.org.Or, print the form, fill it in, and fax it to 734.527.6069.Thank you for joining SCUP!Your membership will become active upon receipt andprocessing of payment. Please allow SCUP five business daysto complete the application process.Upon receiving your confirmation email, log in to theMy SCUP area of the website to review your contact anddemographic information, access member-only benefits, andset your communication preferences.SCUP’s primary vehicle for communications is email; pleaseadd communications@scup.org to your address book toensure you receive updates and other important informationfrom us.Thank you again for becoming part of our community ofhigher education planners from across campus and aroundthe world!INTEGRATED PLANNING FOR HIGHER EDUCATION1330 Eisenhower Place | Ann Arbor, MI 48108734.669.3270 | www.scup.org9/2013 Page 6