MESMEMBERSHIPAPPLICATIONMEMBERSHIPINCLUDES NATIONAL,STATE,ANDLOCALCHAPTER

First / MI / Last
DateofBirth:// / MaleFemale / HaveyoubeenamemberofNSPEin thepast?Yes No
PleasesendmyNSPECorrespondenceandPublicationsto:BusinessHome
I donotwishtobe listedinanymembershiplistsoldbyNSPEtothirdparties
BUSINESS INFORMATION (pleaseprint)
BusinessName: / Title:
BusinessAddress: / City: / State: / ZipCode:
BusinessPhone: / BusinessFax: / BusinessE-mail
PERSONALINFORMATION
HomeAddress: / Homephone: / HomeFax:
City: / State: / ZipCode:
Personale-mail / I amlicensedinthefollowingstates:
ProfessionalLicensure:
PEEIT / LicenseNumber: / NotLicensed / Student
NSPEINTERESTGROUP(NSPEMEMBERSAUTOMATICALLYQUALIFYTOJOINONEOFFIVEPRACTICE-SPECIFICENGINEERINGINTERESTGROUPS)
Construction / HigherEducation / Government / Industry / PrivatePractice
EDUCATION
UndergraduateDegree: / Major: / College/University: / Graduationdate://
GraduateDegree: / Major: / College/University: / Graduationdate://
SPONSORSHIP
WhomaywethankforreferringyoutoNSPE MembersName IDNumber
SPECIALINTRODUCTORYRATES!OFFERVALIDTHROUGHDECEMBER2017
LicensedMember$220*
I holdavalidlicenseasa Professional EngineerintheU.S.orCanada(or internationalequivalent) / Member$220*
I amanEI/EIT,or a graduateof an engineeringprogramaccreditedbythe AccreditationBoardofEngineeringand Technology(ABET)(or international equivalent). / StudentFREE*
I amapersonwhoisenrolledfull-timeinanABET- accreditedengineeringprogramoranengineeringor
pre-engineeringprogramthathasanarticulatedor transferagreementwithABETor anaccredited
program.
PaymentDuesAmountVISAMASTERCARDCHECK
$ / BILLME
CreditCardNo.: / Cardholder’sName:
Exp.Date:// / Signature
I hereby certify that theinformationhereinis complete and accurate. I further certify thatI will abide by therequirementsof the NSPE code of ethics. I also pledge to supportthe constitution, bylaws and board policies (as they are now andas they may be amended) of NSPE and my StateSociety.
ApplicantSignature:Date://
PLEASERETURNAPPLICATIONTO:MES300 Castlewoods Blvd, Ste 10, Brandon MS 39047
NSPEUSEONLY: / No / State / Chap / GradeNPay / SPay / CPay / WEB12

*Newmemberratescovernational,state,andchapterduesforyourfirstyearonly.Theseratesmayvarydependingonyourstateandchapterparticipation;pleasecontact memberservicesat1-888-285-NSPEforparticipatingstates.Renewalratesvarydependingonyourstateandchapter.Membershipratesandrequirementsaresubjecttochange. Contributions(orgifts),duesandfeestoNSPEarenottaxdeductibleascharitablecontributionsfor federalincometaxpurposes.However,they maybetaxdeductibleasordinary andbusinessexpenses.AportionofnationalandstatesocietyduesisnotdeductibletotheextentthatNSPEandyourstatesocietyengageinlobbying.