NEW MEMBER APPLICATION

 

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Tell us about yourself...
Name:           (First / Middle Initial / Last)
Date of Birth:
Sponsor's Name:   (If applicable - Not Required)
Gender:
Male   Female

Work and Home Addresses
Please mail to: Home Work
Home Address:
City/State/Zip:
Home E-Mail:
Home Phone:
Home Fax:
Employer:
Work Address:
City/State/Zip:
Work E-Mail:
Work Phone:
Work Fax:

Professional and Educational Experience
Practice Division Interest:  Construction Private Practice Government Industry Education

Undergraduate Degree:
Major:
College/Univ.:
Date Graduated:
Graduate Degree:
Major:
College/Univ.:
Date Graduated:

For Student Applicants Only
Degree:
Major:
College/Univ.:
Expected Graduation Date:
Professional Licenses:  P.E. State:
License number:
License Year:
E.I. State:
License number:
License Year:

State Dues and Membership Grades
P.E. Member:  Licensed Professional Engineer in any state or US territory or Province of Canada $85.00
E.I. Associate over 30:  E.I. certification in any state; or a graduate engineer ABET accredited engineering program, actively pursuing an engineering career or engaged in post graduate study. $85.00
E.I. Associate under 30:  E.I. certification in any state; or a graduate engineer ABET accredited engineering program, actively pursuing an engineering career or engaged in post graduate study. $65.00
Student:  A Student Member shall be defined as an undergraduate or graduate matriculate of a school or college of engineering or engineering related sciences. $5.00

NSPE Introductory Rate of $110 for the first year of membership.

New member rates covers national, state, and chapter dues. Dues includes subscription to the Louisiana Engineering and Surveyor Journal and PE Magazine. Payments may be deductible under Internal Revenue Code, but are not deductible as charitable contributions.

Payment
Membership services will begin upon approval of application and receipt of full payment. Please make checks payable to LES.
Payment Dues Amount $110 + state =
PAYMENT TYPE (please check one):
Check Visa Mastercard Discover American Express
CARD NO.:
 
EXP. DATE:
CVV Code:
SIGNATURE:
Billing Zip: