Membership Application

Name

First Last

Company Name

Job Title

Preferred Mailing Address

Business

Residence

Business Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Business Phone

Residence Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Residence Phone

Cell Phone (Optional)

Primary Email*

Previously a member of ESWP?

Yes

TYPES OF MEMBERSHIP

Regular – Must possess a college degree in Engineering, Architecture or Science, or equivalent practical experience.

Associate* – Individuals who have an interest in the Society but do not meet the technical requirements.

Life – Members shall be persons who have retired from active business, are sixty years of age or older, and have been members of the Society for fifteen years or more.

Retired – Persons who have retired from primary employment and are at least 55 years of age, but do not meet the tenure requirements of a Life Member.

Student – Full time student or within 2 years of graduation at an accredited college, university or technical school.

*Associate members have the same privileges as regular members, except that they cannot hold office or vote on Society matters.

ENTRANCE FEE AND DUES

1. Any member residing within, or whose place of business is within Pennsylvania, shall be considered a Resident Member. Any member whose residence and place of business is outside Pennsylvania shall be considered as a Nonresident Member.

2. The entrance fee (shown at bottom of form) is to be submitted with application.

3. Annual Dues for membership in the Society are listed below and shall be billed upon membership acceptance.

Please choose Member Type

Regular Member - $230

Non Resident Regular - $120

Associate Member - $230

Non Resident Associate - $120

Government (Full Time) - $50

Non Resident Government - $50

Under age 35 - $25

Student - $0

Under 35 Confirmation

I confirm that I am under 35 years of age

INDUSTRY TYPE

Please list the industries that you work in (e.g., water/wastewater, geotechnical, etc).

PROFESSIONAL EXPERIENCE

This statement must embody a concise narrative of the applicant's professional career, specifying the positions he or she has held, giving names of employers, specifying the work in which he or she has been engaged and the applicant's responsibility in it.

Current Employer

From/To

Position

Previous Employer

From/To

Position

Previous Employer

From/To

Position

EDUCATION

College/University

Degree

Date

College/University

Degree

Date

TECHNICAL/PROFESSIONAL ORGANIZATIONS

I am a member in good standing of the following Professional and/or Technical Organizations

REFERENCES

Only needed if not a member of good standing of a nationally recognized professional or technical society. References must be members of ESWP. (please list at least two members)

Entrance Fee*

Regular, Associate, Government, Under 35 - $55

Retired - $30

Student - $10

Method of Payment for Entrance Fee*

Check - Please mail to; ESWP, 337 Fourth Avenue, Pittsburgh, PA 15222

Credit Card

Dues are billed following acceptance of your application at the ESWP Board of Directors meeting (usually 4th Monday of the month).

Total

Credit Card

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name

Engineers' Society of Western Pennsylvania

Location

ESWP

Engineers' Society of Western Pennsylvania

Membership Application