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Wet along three sides, fold form in half,and seal to close.

ASCE.
AMERICAN SOCIElY OF CIVIL
ENGINEERS

1801 Alexander Bell Drive IReston,VA 20191-4382


tell (8001 548-ASCE (27231 or +1 (7031 295-6300

FOR OFFICE USE ONLY

I fox +1 (7031 295-

6333
e-mail member @osce.org

EXPRESS MEMBERSHIP APPLICATION www.asce.org/ioin


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YOUR NAME
lAST (SURNAME)

FIRST

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0

TITLE:

DATE OF BIRTH (MONTH/DAY/YEAR)


PlEASE SEND MY ASCE CORRESPONDENCE TO MY:

0 MR.

0 RESIDENCE

0 MRS. 0 MS.

0 DR . 0 PROF.

0 OTHER

0 WORKPlACE

RESIDENCE ADDRESS

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.

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CITY

REET

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0

STATE/PROVINCE/COUNTRY
CODE

ZIP/POSTAL

PHONE

EMAil

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YOUR EMPLOYER
COMPANY NAME

JOB TITLE STREET


CITY

STATE/PROVINCE/COUNTRY

ZIP/POSTAL

FAX

CODE PHONE

EMAil

EDUCATIONAL BACKGROUND (UNDERGRADUATE DEGREE)


COLLEGE/UNIVERSITY
MAJOR

GRADUATION DATE (MONTH/YEAR)

PROFESSIONAL LICENSURE
0 REGISTERED ENGINEER

0 NOT LICENSED

PRIMARY STATE/COUNTRY

REG.#

EXP. DATE

Your ASCE membership includes free membership in one of ASCE's specialty Institutes. Please check the one you would like to be enrolled in:
0 ARCHITEGURAL ENGINEERING INSTITUTE (AEI)
0 ENGINEERING MECHANICS INSTITUTE (EMI)
0 STRUQURAEl NGINEERING INSTITUTE (SEI)

0 COASTS,OCEANS,PORTS & RIVERS INSTITUTE (COPRI)


0 ENVIRONMENTAL & WATER RESOURCES INSTITUTE (EWRI)
0 TRANSPORTATION & DEVELOPMENT INSTITUTE {T&DI)

0 CONSTRUGION INSTITUTE
{CI)
0 GEOINSTITUTE (GI)

Calculate Your Dues Please calculate your dues based on the dues schedule below. For a more complete description of ASCE
member grades, visit www.asce.org/membergrades.
1. Members, Associate Members, and Affiliate Members ( not recent BS grads): $225.00
2. Associate Members and Affiliate Members who are recent recipients of a Bachelor's degree are entitled to a sliding
dues schedule. Dues are based upon the year the Bachelor's degree was gra nted:
Year of graduation: $50.00
First year after receipt of Bachelor's degree: $50.00
Second year after receipt of Bachelor's degree: $85.00
0 VISA
PLEASE CHARGE MY: 0 AMERICAN EXPRESS

Third yea r after receipt of Bachelor's degree:-$1 25.00


Four th year after receipt of Bachelor's degree: $1 75.00
Fifth year after receipt of Bachelor's degree: $225.00
0 MASTERCARD

0 DISCOVER

0 DINERS CLUB

0..

PAYMENTAMOUNT$------ ---- -- -------- ------ ---- ------------ ---- ----

CARD #

EX DATE

SIGNATURE -- ---- ------ ---- ---- ---- ---------- -- --------- DATE---- ------------------ --------------BY SIGNING ABOVE,I WILL ADHERE TO THE CONSTITUTION,BYlAWS, RULES OF POLICY AND PROCEDURE,AND CODE OF ETHICS OF ASCE AS
STATED IN ININ'N.ASCE.ORG/COMPLY. Return to ASCE MEMBERSHIP DEPARTMENT, PO BOX 79084, BALTIMORE,MD 21 298-8506.

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