Membership Application



APPLICATION FOR: Member Affiliate Associate Member Reinstatement
          or
CHANGE OF GRADE TO: Member Affiliate
   If Change of Grade, provide Member #
PERSONAL INFORMATION
Title/Rank

First Name(required)

Last Name(required)

E-Mail
 		Dr.     Mr. Mrs. Ms.

Middle Name

Birthdate(required)

Personal URL
HOME INFORMATION
Address(required)

City(required)
 		Home Telephone Number (Area Code/Number)

State/Province/Country(required)

ZIP/Postal Code(required)
BUSINESS INFORMATION
Company, Organization or Agency

Address

City

Business URL


Indicate Mailing Preference: Business Home 		Job Title

Business Telephone Number (Area Code/Number)

Business FAX Number (Area Code/Number)

State/Province/Country

ZIP/Postal Code

Citizen of
EDUCATION HISTORY
GRADE CHANGE:     Provide all NEW information since original application.
REINSTATEMENT:    Complete if membership lapsed more than 2 years.
COLLEGE OR UNIVERSITY & LOCATION(required) MAJOR DEGREE DATE DEGREE RECEIVED








PROFESSIONAL HISTORY
GRADE CHANGE:     Provide all NEW information since original application.
REINSTATEMENT:    Complete if membership lapsed more than 2 years.
Date of Each Position (Mo/Yr) Employment Information
Provide detailed information regarding each position held in date order, or send us your resume. 		Total Time In Position (Yrs/Mos) Portion of time in Responsible Charge of Work (Yrs/Mos)
From
 		To
 		Position

Firm

Specific Duties

 		Yrs/Mos
 		Yrs/Mos
From
 		To
 		Position

Firm

Specific Duties

 		Yrs/Mos
 		Yrs/Mos
From
 		To
 		Position

Firm

Specific Duties

 		Yrs/Mos
 		Yrs/Mos
From
 		To
 		Position

Firm

Specific Duties

 		Yrs/Mos
 		Yrs/Mos
From
 		To
 		Position

Firm

Specific Duties

 		Yrs/Mos
 		Yrs/Mos
CONTRIBUTIONS, LICENSES AND MEMBERSHIPS
Describe significant contributions in your field, such as important projects, major contributions to periodicals, publications, honors, awards, membership in honorary societies and participation on committees, etc.
PROFESSIONAL LICENSES (State of Registry and Type)
MEMBER OF FOLLOWING SOCIETIES
RINA
IME
NECI 		ASME
ASCE
AIChE 		AIAA
ASNE
MTS 		IEEE
NSPE
ENDORSEMENTS
Name of sponsors (SNAME/ASNE member) (required)



 Member Grade



DUES
  • January - May 1st, price is $20.00 entrance fee, plus $125.00 dues ( 50% if under 30 years of age).
  • May 2 - September 30, full entrance fee plus 50 % of current dues payment
  • October 1 - December 31st, full dues as above, but membership runs to December 31 of the following year.
METHOD OF
(required)
Check enclosed with application
Pay now with credit card. (Member benefits commence 3 weeks after receipt of dues payment.)

MasterCardVISAAmerican Express

Account Number

Expiration Date

APPLICANT'S SIGNATURE
I certify that the statements made in this application are correct. I pledge to abide by the Bylaws of the Society and the Society's Code of Ethics. (Please submit the application and then print out a copy of the form, sign it and fax it to: (201) 798-4975, or mail to: SNAME, 601 Pavonia Ave., Jersey City, NJ 07306. Thank You


Signature: Date:




If you have any questions regarding student registration, contact Tommie-Anne Faix.