Professional Membership Application

AMERICAN SOCIETY OF MECHANICAL ENGINEERS

Technical Divisions Choose up to Five (in priority order):

27 Advanced Energy Systems

29 Materials & Energy Recovery 04 Materials Handling Engineering 39 Microelectromechanical Systems 41 Nanotechnology Institute 33 NDE Engineering 32 Noise Control and Acoustics 17 Nuclear Engineering 35 Ocean, Offshore & Arctic Engineering 16 Petroleum 40 Pipeline Systems 21 Plant Engineering and Maintenance 19 Power 28 Pressure Vessels and Piping 12 Process Industries 18 Rail Transportation 07 Safety Engineering and Risk Analysis 30 Solar Energy 24 Technology and Society 15 Tribology

Instructions: Complete all applicable elds and mail with payment to: ASME, 22 Law Drive, P.O. Box 2900, Faireld, NJ 07007-2900, or fax to: 1-973-882-1717. Applications without payment will not be processed. For assistance completing this application, please call 1-973-882-1167 or 1-800-THE-ASME, or email questions to customercare@asme.org. You can also join online at: www.asme.org/membership

01 Aerospace 02 Applied Mechanics 09 Bioengineering 31 Computers & Information in Engineering 14 Design Engineering

2012-2013 Membership Dues Schedule Choose one:

q Member or Afliate (see page 2 for denition). . . . . . . . . . . . . . . . . . . . . . . . . . $144 USD q Member within 1 year of graduation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 57 USD q Member within 2 years of graduation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $ 79 USD q Member within 3 years of graduation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $100 USD q Member within 4 years of graduation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . $122 USD ___________________________________________________ _________________ Last Name/Family Name ______________________________________ ___________ First Name/Given Name Initial q M qF ______________ Gender

25 Dynamic Systems and Control 34 Electronic and Photonic Packaging 23 Environmental Engineering 36 Fluid Power Systems and Technologies 08 Fluids Engineering 11 Heat Transfer 38 Information Storage and Processing Systems 05 Internal Combustion Engine 22 International Gas Turbine Institute 03 Management 13 Manufacturing Engineering 10 Materials

___________________________________________________ _________________ Birthdate MM / DD / YYYY (you must include exact birthdate with year) ___________________________________________________ _________________ Company ___________________________________________________ _________________ Primary (Mailing) Address qHome qBusiness ___________________________________________________ _________________ (please attach additional sheet if more space is needed for address) ______________________________________ _________ __ ________________ City State/Province Country ___________________________ _________ ______________________________ Zip/Postal Code Telephone Number (including area code) ___________________________ _________ ______________________________ Email Address Fax Number (including area code)

Dues Payment Information Payment by: q Check q AmEx q Visa q Mastercard q Discover q Euro Card q Money Order

$_______________________________________________
Please enter the dues amount you checked in the Member Dues section above. Residents of certain countries may be eligible for additional discounts. Please see reverse side for country listing.

________________________________________________ Credit Card Number ___________________________ ____________________ Exp. Date (MM/YY) Security Code (CSC/CVV2) ________________________________________________ Cardholder Name ________________________________________________ Cardholder Signature

Afnity Groups Choose up to three (optional):

1. Entrepreneurs Network 2. ASME International Outreach 3. Women in Engineering 4. Early Engineer Connect 5. ECLIPSE 6. Grad Students 7. Engineers Without Borders 8. Student Liaisons 9. Operacion y Manteniminto de Calderas (Latin American Group on Boiler Operation and Maintenance) 10. Precollege Education

(A) I authorize the Society to verify the information contained in this application and, to that end, to contact any educational institution, professional society, publisher, employer, or otherentity named or identied in this application or in any document submitted in support of this application. I hereby consent to and authorize the release and disclosure to ASME of any information records or correspondence as required to verify the information in the application, which is held by any such entity identied in this application. (B) I subscribe to the above and, if elected to any grade, will be governed by the Constitution and By-Laws of the Society and its Code of Ethics as long as I continue as a member. I furthermore agree to promote the objectives of the Society so far as shall be in my power.

Please complete all sections on back side of application.

ASME Grades of Membership

C3.1.5 A Member, at the time of admission or advancement to that grade, shall have attainments amounting to the equivalent of at least eight years of engineering experience. C3.1.6 An Afliate should be a person who is capable of and interested in rendering service to the eld of engineering; and whose work should be so related to applications of engineering that admission to this grade will contribute to the welfare of the Society.
Membership grades will be assigned based on information provided with this form. Additional information may be required for other grades.

Professional History
Select a code based on your Principal Job Function
01 02 03 13 14 04 05 06 11 15 12 07 08 General or corporate management Product design, including applied research and development Systems design, including applied research and development Design of equipment for in-plant use Other design engineering functions Production engineering (processing or manufacturing) Testing, reliability assurance, quality control, and standards Plant engineering, operations, and maintenance Basic research & development Other process engineering functions Consulting Education Other-please specify:___________________________________________

Select a code that best describes your Title

Engineering
31 32 33 34 Corporate V.P. for Engineering, Director, etc. Chief Engineer, Senior Engineer, etc. Project Manager Other (e.g. Engineer, Allied Scientist)

Non-Engineering
35 36 37 38 President, Owner, etc. Vice President, Senior Manager, etc. Project Manager, Manager, or Supervisor Other (e.g., sales, marketing)

College(s) / University(ies) Attended

College/University Location Degree Area of Study Date of Degree

Professional Record (attach resume or curriculum vitae)

Name of current employer Job Title Length of time in current job

1.q No Degree 2.q B.A. 3.q B.E. 4.q B.S. 5.q M.A. 6.q M.S. 7.q M.E. 8.q Ph.D. 9.q Sc.D. 10.q Other (Describe)____________

years:

months:

Reference Please complete to the best of your ability.

q Check box if your reference is an ASME Member
Name___________________________ Company__________________________ Address________________________________ City_______________________ State/Province_____________ Postal code____________ Country_______________ Email _____________________________ Telephone_______________________

Professional Engineering Registration q P.E.

State/Country License No. Date of Issue

COUNTRIES ELIGIBLE FOR 50% DUES DISCOUNT

AFGHANISTAN BANGLADESH BENIN BHUTAN BURKINA FASO BURUNDI CAMBODIA CHAD COMOROS CONGO, DEM. REP COTE D'IVOIRE DJIBOUTI ERITREA ETHIOPIA GAMBIA GHANA GUINEA GUINEA - BISSAU HAITI INDIA KENYA KYRGYZ REPUBLIC LAOS LIBERIA MADAGASCAR MALAWI MAURITANIA MONGOLIA MOZAMBIQUE MYANMAR NEPAL NIGER NIGERIA PAKISTAN RWANDA SENEGAL SIERRA LEONE SOLOMON ISLANDS TAJIKISTAN TANZANIA TIMOR-LESTA TOGO UGANDA UZBEKISTAN VIETNAM YEMEN ARAB REPUBLIC ZAMBIA ZIMBABWE

COUNTRIES ELIGIBLE FOR 25% DUES DISCOUNT

ALBANIA ALGERIA ANGOLA ARMENIA AZERBAIJAN BELARUS BELIZE BHUTAN BOLIVIA BOSNIA & HERZEGOVINA BULGARIA CAMEROON CAPE VERDE COLOMBIA CONGO REP CROATIA ECUADOR EGYPT EL SALVADOR FIJI ISLANDS GEORGIA GUATEMALA GUYANA HONDURAS INDONESIA IRAN IRAQ JAMAICA JORDAN KAZAKHSTAN KIRIBATI KOSOVO LAO PDR LESOTHO MALDIVES MARSHALL ISLANDS MICRONESIA, FED. STS. MOLDOVA MOROCCO NAMIBIA NICARAGUA PARAGUAY PEOPLES REP/CHINA PERU PHILIPPINES SAMOA SAO TOME AND PRINCIPE SERBIA SRI LANKA-CEYLON SURINAME SWAZILAND SYRIAN ARAB REPUBLIC THAILAND TONGA TUNISIA TURKMENISTAN TUVALU UKRAINE VANUATU WEST BANK AND GAZA

ASME
22 Law Drive, P.O. Box 2900, Faireld, NJ 07007-2900 Phone: 973-882-1167 (Global) 800-THE-ASME/800-843-2763 (U.S./Canada) Fax: 973-882-1717 Email: customercare@asme.org

6/2012