IBM South Florida QCC & Alumni Association
Membership Application

*****NOTE - NEW MEMBERS WILL GET FREE MEMBERSHIP THROUGH DEC 2022 - NO NEED TO PAY*****

Annual membership dues are $20.00 (or $100 for a Lifetime Membership (Florida resident)/ $75(non-Florida resident))   

Please complete this application online by typing the required information into each box. Fields followed by an asterisk (*) are required. 

Last Name: *  Please enter your Last Name.

First Name: *  Please enter your First Name.      Middle Initial:   

Spouse/ Other Name:

Prime Area:
(e.g. Engineering, Manufacturing, etc.)

Years of Service (whole number):   * Please enter your Years Of Service with IBM. Please round 'Years Of Service' to a whole number.

Membership Type:  QCC IBM Employee 5 years+ Lifetime Member Trial Member Spouse Deceased Member * Please enter your Membership Type.

Address:

City:       State:    5-digit Zip Code: Please enter a 5-digit Zip Code

Phone:           ( )        Cell:      ()

E-Mail Address: *
Please enter your Email Address or that of a friend or family member who has agreed to pass on Association correspondence to the applicant. Member email already exists.

E-Mail (Verify): *
Please Verify your Email Address. Email Address must match Email(Verify).

By submitting this application for membership, you are releasing the officers, members, and agents from liability in case of accident, injury or misadventure in connection with Association activities. Please review the Bylaws on this website for more information.

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Signature

Your membership has not been submitted until you see the
"Your Membership Information has been submitted" screen.