GREENSBORO ENGINEERS CLUB

NEW MEMBERSHIP FORM

QUALIFICATIONS: Applicant shall be a registered professional engineer or architect, or a graduate of an accredited technical school, or be actively engaged in a branch of industry or science relating to engineering or architecture for a period of six (6) years.

 Name:                              

 Spouse's 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 

 Employer:                         

 Employer's Address:         

                                          Street Address                                              Suite

                                          City                                State      Zip Code                   

 Employer's Phone Number:

 Employer's Fax Number:   

 Email Address:                   

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

 Preferred Mailing Address Home  Work 

PROFESSIONAL EDUCATION

SCHOOL LOCATION DEGREE/COURSE DATE

 School:  

 Location:  

 Degree:  

Course:    

Date:  

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PROFESSIONAL EXPERIENCE

FROM/TO POSITION EMPLOYER / ADDRESS / PHONE

 From:     To:

 Position:  

 Employer:  

 Employer's Address:    

 Employer's Phone:  

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TECHNICAL ORGANIZATION MEMBERSHIP

 Name:            Years:    

 Name:            Years:      

 Name:            Years:    

 Name:            Years:    

 Member Who referred you: