GREENSBORO ENGINEERS CLUB

 YEARLY RENEWAL FORM

 Name:                              

 Mailing Address:                

                                          Street Address                                              Suite

                                          City                                State      Zip Code               

 Phone Number:                 

 Fax Number:                      

 Email Address:                   

 Email Address:                   (retype in case of type-o)

 Professional Engineer          Yes  No 

 New Members to complete the following:

 Employer                          

 Employer's Address          

                                          Street Address                                              Suite

                                          City                                State      Zip Code                   

 Are you a Lifetime Member?     Yes  No     

If you are a Lifetime Member, no dues are required, but please submit this form with current information to ensure that the roster information is correct.  Lifetime membership requirements….(link to be added soon)

Checks payable to Greensboro Engineers Club and should be send to:

Scarlett Kitts

Trigon | Kleinfelder

313 Gallimore Dairy Road

Greensboro, NC 27407