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SIAEA Membership Application (Step 1 of 4)

Step 1: Member Registration

(Associate/Student Membership: $20 per calendar year, Annual Membership: $30 per calendar year, Life  Membership: $200 one time fee)

   *Required

Contact Information
First Name:*
Middle Initial:
Last Name:*
Address:*
City:*
State:*
Zipcode:*
Day Time Telephone:*


e.g: xxx-xxx-xxxx
Evening Telephone:

e.g: xxx-xxx-xxxx
Cell Phone:

e.g: xxx-xxx-xxxx
Email where you want to Receive SIAEA Correspondance:*
Password:*
Confirm Password:*
Recommended By First and Last Name (Must be an SIAEA Member):*

Qualifications
Qualifications:* Engineer


Engineer (PE)


Architect


Architect (RA)


Student


Other:
Please enter your professional license number, if applicable:
University:*
Degree:*


e.g: B.S, M.S, M.E, etc.
Graduation Year:*

Employment Information
Please select the statement that most closely reflects your employment status:* I am currently not employed


I am currently not employed, but am actively seeking employment


I am employed, in an entry level position


I am employed, in a managerial position


I am employed, and a proprietor/partner at my organization
Company Name:*


If unemployed or retired please mark N/A
Company Industry Sector:*


If unemployed or retired please chek Other and mark N/A		 Government or Public


Private


Construction Industry


Other:
Job Title:*


If unemployed or retired please mark N/A
Company Address:*


If unemployed or retired please mark N/A
Company Telephone Number:*


If unemployed or retired please mark N/A

e.g: xxx-xxx-xxxx
Company Email Address:*


If unemployed or retired please mark N/A
Company Services:*


If unemployed or retired please mark check Other and mark N/A		 Engineering Design Consulting


Architecture Design Consulting


Project Management


Construction Management Services


Other:

Volunteer Services
Would you like to serve on an SIAEA working committee?* Yes


No


Yes, but at a later time
Working Committee Area of Interest Membership Development


New Initiatives


Seminars and Professional Development


Employment Network


Student Liaison


Events Committee


Other:

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