Nomination Form for Life Membership The Society’s Board of Directors, after nomination by a chapter Board of Directors, may grant upon verification of retirement, Life Membership status to any retired person who has been a Member in good standing continuously during the past ten (10) years and has demonstrated significant contributions to the chapter and the Society. The Life Member shall also have reached the age of sixty (60) years and no longer be active in the profession. All the rights and privileges of his/her membership shall also pertain to this membership category, except that Life Members shall not be required to pay annual dues. Nominating Chapter Name Chapter President Name ASPE Member Nominated for Life Membership First Middle Last Membership Number Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone Email Describe Demonstrated Contributions (non-monetary) to the CHAPTEREXAMPLES: Service as Officer or Board of Directors; service as member/chair committees; provided leadership for technical, legislative, education, and/or membership activities and/or events; significant activity or event for community benefiting Chapter or Society; other significant contributions, assistance or endeavors on behalf or Chapter or Society.Describe Significance of ContributionDescribe Demonstrated Contributions (non-monetary) to the SOCIETYEXAMPLES: Service as Officer or Board of Directors; service as member/chair committees; provided leadership for technical, legislative, education, and/or membership activities and/or events; significant activity or event for community benefiting Chapter or Society; other significant contributions, assistance or endeavors on behalf or Chapter or Society.Describe Significance of ContributionAdditional pertinent information that should be considered.Certification by President of Chapter Nominating ASPE Member for Life MembershipThe undersigned certifies that all statements made herein are true and that the Chapter Board of Directors has approved this nomination. Signature of Chapter President Date
