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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

Choose Membership Type
Associate/Student Membership: $20 per calendar year
Annual Membership: $30 per calendar year
Life Membership: $200 per calendar year

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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