University Degree / Other Academic Qualifications

Please list your academic and professional qualifications

Other Professional Certifications

Please list any other profession certificate that you hold

Part 2: REFERENCES

A reference must be supplied before the application can be processed.
I certify that the above application for admission to the Chartered Institute of Management Consultants® has been personally known to me and that the applicant is, to my knowledge, of good character, and in my opinion is a suitable person to be admitted as a member of the institute.
To the best of knowledge the details of his/her application are correct.

Waiver Form

I certify that the information declared in the application form for membership and certification is correct. If I would misrepresent my credentials or allow my membership in the Chartered Institute of Management Consultants® to lapse, I understand and agree that my CIMC Status will be revoked, and my membership terminated. I affirm that all the information that I have provided to CIMC Status is true, correct, and complete and I agree to hold harmless and indemnify the CIMC and its officer, directors, employees and agents for any misrepresentations of my credentials and for all claims, loss, damage, judgment, or expense. I certify that I have not been convicted of a felony. I have not been disciplined for any ethical violation in the last ten year and I am not under any investigation by any legal or licensing board.
Membership of CIMC does not constitute the grant of a license or other licensing authority by or on behalf of the organization as to a member’s qualifications, abilities, or expertise.
The Chartered Institute of Management Consultants® does not endorse, guarantee, or warrant the credentials, work, or options of any individual member.