Structural Engineering Institute Membership Application

* required information


Title: Mr. Mrs. Ms. Dr. Prof. Other
Business Title:
* First Name:
Middle Name:
* Last Name:
Suffix:


I am currently a member of ASCE and wish to select SEI as my primary Institute at no additional cost.
ASCE Member ID - * Must provide if currently an ASCE member
I am currently a member of ASCE and G-I/AEI/EWRI/COPRI/CI and wish to join SEI as an additional institute.
I would like to join SEI only.
I would like to join ASCE and receive a complimentary membership in SEI. (you will be linked to an ASCE membership application)




Personal Information (Complete this section if you are not already an ASCE member or if you want to correct ASCE Membership data)

Residence

* Address:
* City: * State: * ZipCode:
Country:
Phone:
* E-mail:




Business

Name of Employer:
Address:
City: State: Zip:
Country:
Phone:
Fax:




Preferred Mailing Address: Residence Business



Date of Birth



Educational Information

Please use appropriate abbreviations when possible. Please list all degrees received or being pursued, using appropriate abbreviations (i.e., BSCE, MSCE, Ph.D., MBA, MSEM)

College/
University		 Dates Attended/
Attending		 Degree/
Major		 Graduation
Date




Name of Employer
& Name, Title
of Supervisor
Length of
Employment
 Position Description/
Assignment
Years Months
Years Months
Years Months
Years Months
Years Months


How many years have you participated in the structural engineering industry?

Please provide a brief statement describing your participation in the structural engineering industry.




Professional Licenses and Associations

Please list professional licenses and professional association affiliations:




Payment Information and Signature


Membership
Category
Qualifications
ASCE and SEI Joint Membership ($205) Membership materials for ASCE will be forwarded to you.
SEI Membership as an Additional Institute ($20) For current members of ASCE and one of its specialty Institutes.
SEI-Only Membership ($205) For individuals engaged in the development of policies and programs related to structural engineering including the planning, design, construction, operation, management, and regulation of associated engineered works- including students




*Annual dues do not need to be included with your application. You will be invoiced for dues once your application has been processed.

I authorize the Institute to verify the information contained in this application and, to that end, to contact any educational institution, professional society, publisher, employer, or other entity named or identified in this application or in any document submitted in support of this application. I hereby consent to and authorize the release and disclosure to the Structural Engineering Institute of any information, records or correspondence as required to verify the information in the application, which is held by any such entity identified in this application.