2004 Membership Application

Important ASPE Documents:

Fill out the membership application below and pay with your credit card online or
download the ASPE Membership Application (PDF Format, 64KB) and mail or fax the completed document.



Please TAB between fields. Pressing RETURN/ENTER will send the form.
*All fields required.
Prefix:
 Mr. Ms. Miss Mrs.
*First Name:
Nickname:
Middle Name:
*Last Name:
*Birth Date:
*Residence Street Address:
*City:
*State:
 (Leave blank for non-US address.)
*Zip/Postal Code:
 (Indicate country for non-US address.)
*Home Phone:
*E-Mail Address:
   
*Business Organization Name:
Title:
*Business Address:
*City:
*State:
 (Leave blank for non-US address.)
*Zip/Postal Code:
 (Indicate country for non-US address.)
*Business Phone Number:
Fax Number:
*Business E-Mail Address:
   
Certifications - Please check all that apply
P.E. CIPE CPD Graduate Engineer
Other Organizations

ASHRAE NAPHCC ASSE MCCA PCA NSPE
Mechanical and Civil Engineers Other

*Primary Address? (To which address should ASPE information be sent?) Residence Business
*Have you previously applied for or held membership in the Society? Yes No
Which Chapter do you wish to affiliate with? About ASPE Chapters | Why Join a Chapter?
*Educational Record
  Name of Institution Course or Major Date (Mo/Yr)
 Graduation
Date 		Degree or Diploma
From to
High School
College/University
Technical School
Others

*Professional Experience
Date (Mo/Yr)
   Class      
From To Firm Name and Address (see below) Title Description Degree of Responsibility
*Classification of Firm: A - Arch./Engineer. or Cons.Engr B - Govt. Agency C - Mfr. or Mfr's. Rep.
  D - Educ. Inst. E - Contractor F - Other




Registration (P.E.)
State Certificate No. Branch

 

 
*References
(References should be in engineering profession, ASPE members preferred. ASPE reservers the right to contact references.)
Name Address Telephone
Promo Code:
If you have a promo code, please enter it here.

Sponsorship:
If you have the sponsor's name and ID, please enter it here. | What is a Sponsor?

Sponsor's Name:

Sponsor's ID Number:

*Security:
For security purposes, please enter your mother's maiden name.

Notes or Comments:

*Membership Dues ($USD)
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Full
$175.00 (plus $25 application fee)
Associate
$155.00 (plus $25 application fee)
Affiliate
$175.00 (plus $25 application fee)
Special
$175.00 (plus $25 application fee)
Government
$175.00 (plus $25 application fee)
Student
$20.00
Explanation of Membership Classifications

Dues: Please pick the appropriate membership classification and send the correct dues with this application. In the event the membership classification is changed, a corrected dues statement (or dues overpayment refund) will be sent with your notice of election. Dues are paid annually on the anniversary date of membership. A non refundable $25 application fee will be automatically charged for all applications except student membership applications.

*Credit Card Information

Visa
MasterCard
AMEX
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*Name (As it appears on the card)
*Street Address (Billing Address for Card. Any other address will cause the card to decline.)
*ZipCode
*Credit Card Number
Do Not Use Spaces or Symbols Between Numbers.
*Exp Date: (YYMM format only, extra characters will cause the card to decline.)
Must use format YYMM, do NOT use MMYY! April 2007 enters as 0704.

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