APPLICATION FOR MEMBERSHIP
Chattanooga Engineers Club
CHATTANOOGA ENGINEERS CLUB
P.O. Box 4031
Chattanooga, Tennessee 37405
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(Name in Full)
Title_________________________________________________________________
(Professional Position or Occupation)
Date____________________ Signature_________________________________
Makes application for admission to the Chattanooga Engineers Club on the basis of professional or business experience given herewith, and promises if elected, to conform to the rules of membership. The grade of membership applied for is:
- Student ($15 annual)
- Full ($50 annual)
- Associate ($50 annual)
- Associate Eligible for Full ($50 annual)
- Retired (no applications, see Section 6)
REFERENCES
Signatures of references are not required
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Three or more references to club members are requested. An applicant not personally acquainted with three members may give non-members as references.
RECORD OF TRAINING AND PROFESSIONAL EXPERIENCE
Name_____________________________________ Date of Birth____/____/______
State Registration (List State(s))_________________________________________
Name for Badge_____________________ Spouse’s Name___________________
Company/Organization________________________________________________
Present Occupation (Job Title)__________________________________________
BUSINESS
Business Address_____________________________________________________
City________________________________ State________ Zip_________________
Telephone___________________________ FAX____________________________
HOME
Home Address________________________________________________________
City________________________________ State________ Zip_________________
Home Telephone___________________Other (Cell or FAX)___________________
Please send postal items to:
Business Address
Home address
Post Office Box___________ City_________________ State____ Zip_________
Please send email items to:
Email_______________________________________________
Personal email or business email for meeting notices, etc. (CEC policies do not permit misuse of address)
EDUCATION AND EXPERIENCE
(Include Degrees, when and where obtained)
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Statement of professional experience Give periods of employment, names of employers, location and brief description of duties:
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