Enterprise Membership Confirmation Form

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Name of Enterprise (as to be reflected in NSPE records):


Number of Employees to be NSPE members under this enterprise agreement:


**Please email a list of the names AND location (city, state, ZIP) of the members above to les@les-state.org.
that information will allow us to create an itemized, cumulative dues invoice and
personalized membership applications.

Primary Enterprise Contact (to receive all enterprise info from NSPE, inc. dues invoice):

Contact Person:

On behalf of the above-noted enterprise, I confirm our commitment to fulfilling an
enterprise membership program with NSPE: