Membership Activation Form for ASME Complete and return this form to ASME within ASME Grades of Membership

Non-Member Course & Conference A!endees 90 days of receipt of your notification email to C3.1.5 A Member, at the time of admission or advancement to that grade, shall have attainments amounting to the equivalent of at least eight years of engineering experience.
Activate Your Complimentary Membership! (Note: A degree in an approved engineering curriculum or a baccalaureate degree in an approved engineering technology curriculum shall be accepted as equivalent to the
AMERICAN SOCIETY OF MECHANICAL ENGINEERS eight-year experience requirement.)

C3.1.6 An Affiliate should be a person who is capable of and interested in rendering service to the field of engineering; and whose work should be so related to applications of
Congratulations, you are eligible to receive One Year of Free engineering that admission to this grade will contribute to the welfare of the Society.
ASME Membership for attending an ASME Course or Conference!* Membership grades will be assigned based on information provided with this form. Additional information may be required for other grades.
Learn about ASMEs valuable Member Benefits at: www.asme.org/membership
Professional History
Instructions: Please complete all applicable fields on this writable .pdf form and return WHAT INTERESTS YOU? Choose up to eight: Select a code based on your Principal Job Function Select a code that best describes your Title
to ASME within 90 days after your course or conference via Email: customercare@ Connect with engineering professionals and participate in as many 01 General or corporate management Engineering
asme.org, Fax: 1-973-882-1717, or postal mail: ASME Service Center, 150 Clove interest groups as you would like from the list below. ASME groups allow 02 Product design, including applied research and development
Road, 6th Floor, Little Falls, NJ 07424-2100. For assistance completing this application, engineers and technical professional to receive relevant information and 31 Corporate V.P. for Engineering, Director, etc.
engage with others who share similar interests throughout the world. 03 Systems design, including applied research and development
please send questions to the email address above or call 1-646-616-3100 (Global) or 32 Chief Engineer, Senior Engineer, etc.
Indicate up to 8 selections. To become an online Participant in these and 13 Design of equipment for in-plant use
1-800 -THE-ASME / 800-843-2763 (U.S./Canada). 33 Project Manager
other groups beyond the available fields below, visit our website at
* One year free membership offer is only available only to ASME non-members taking an ASME 14 Other design engineering functions
www.asme.org/groups 34 Other (e.g. Engineer, Allied Scientist)
Public Course or attending an ASME Conference who have paid the full non-member rate. 04 Production engineering (processing or manufacturing)
05 Testing, reliability assurance, quality control, and standards
Non-Engineering
27 Advanced Energy Systems 13 Manufacturing Engineering 06 Plant engineering, operations, and maintenance
____________________________________________________________________ 35 President, Owner, etc.
11 Basic research & development
Name of ASME Course or Conference You Attended 01 Aerospace 10 Materials
15 Other process engineering functions 36 Vice President, Senior Manager, etc.
02 Applied Mechanics 29 Materials and Energy Recovery
____________________________________________________________________ 12 Consulting 37 Project Manager, Manager, or Supervisor
42 ASME International Outreach 04 Materials Handling Engineering
Last Name/Family Name 07 Education 38 Other (e.g., sales, marketing)
09 Bioengineering 39 Microelectromechanical Systems
M F 08 Other-please specify:___________________________________________
______________________________________ ___________
______________ 31 Computers & Information 41 Nanotechnology Institute
in Engineering
First Name/Given Name Initial Gender 32 Noise Control & Acoustics
14 Design Engineering
33 Nondestructive Evaluation, College(s) / University(ies) Attended Professional Record (attach resume or curriculum vitae)
____________________________________________________________________ 25 Dynamic Systems & Control Diagnosis, and Prognosis College/University Location Degree Area of Study Date of Degree
Birthdate MM / DD / YYYY (you must include exact birthdate with year) 44 Early Career (Connect) 17 Nuclear Engineering
Name of current
employer
45 ECLIPSE 35 Ocean, Offshore & Arctic
____________________________________________________________________ 34 Electronic & Photonic Packaging
Engineering
Job Title
Company 16 Petroleum
23 Environmental Engineering
40 Pipeline Systems Length of time in
____________________________________________________________________ 47 Engineers Without Borders current job years: months:
21 Plant Engineering & Maintenance
Primary (Mailing) Address Home Business 48 Entrepreneur's Network
19 Power
36 Fluid Power Systems & Technology 1. No Degree 2. B.A. 3. B.E. 4. B.S. 5. M.A. 6. M.S.
____________________________________________________________________ 08 Fluids Engineering
50 Pre-College
7. M.E. 8. Ph.D. 9. Sc.D. 10. Other (Describe)____________
(please attach additional sheet if more space is needed for address)
46 Grad Students
28 Pressure Vessels & Piping Reference Please complete to the best of your ability.
11 Heat Transfer
12 Process Industries Check box if your reference is an ASME Member
______________________________________ ___________ ________________
18 Rail Transportation
City State/Province Country 38 Information Storage & Professional Engineering Registration P.E. Name___________________________ Company__________________________
Processing Systems 07 Safety Engineering & Risk Analysis State/Country License No. Date of Issue
________________ __________________________________________________ 05 Internal Combustion Engine 30 Solar Energy Address________________________________ City_______________________
Zip/Postal Code Telephone w/area code Mobile Home Business 22 Intl Gas Turbine Institute 51 Student Liaisons
State/Province_____________ Postal code____________ Country_______________
49 Latin American Boiler Users Group 24 Technology & Society
___________________________ _______________________________________ 03 Management 15 Tribology Email _____________________________ Telephone_______________________
Email Address Fax Number (including area code)
43 Women in Engineering

(A) I authorize the Society to verify the information contained in this application and, to that end, to contact any educational institution, professional society, publisher, employer, or otherentity named
or identified in this application or in any document submitted in support of this application. I hereby consent to and authorize the release and disclosure to ASME of any information records or
correspondence as required to verify the information in the application, which is held by any such entity identified in this application. ASME Service Center 150 Clove Road, 6th Floor, Little Falls, NJ 07424-2100
(B) I subscribe to the above and, if elected to any grade, will be governed by the Constitution and By-Laws of the Society and its Code of Ethics as long as I continue as a member. I furthermore Phone: 1-646-616-3100 (Global)
agree to promote the objectives of the Society so far as shall be in my power. 1-800-THE-ASME/1-800-843-2763 (U.S./Canada)
Fax: 1-973-882-1717 Email: customercare@asme.org
8/2015
Please complete all sections on back side of application.
Market Code: PCCAPP16
 Membership Activation Form for ASME Complete and return this form to ASME within ASME Grades of Membership
Non-Member Course & Conference A!endees 90 days of receipt of your notification email to C3.1.5 A Member, at the time of admission or advancement to that grade, shall have attainments amounting to the equivalent of at least eight years of engineering experience.
Activate Your Complimentary Membership! (Note: A degree in an approved engineering curriculum or a baccalaureate degree in an approved engineering technology curriculum shall be accepted as equivalent to the
AMERICAN SOCIETY OF MECHANICAL ENGINEERS eight-year experience requirement.)

C3.1.6 An Affiliate should be a person who is capable of and interested in rendering service to the field of engineering; and whose work should be so related to applications of
Congratulations, you are eligible to receive One Year of Free engineering that admission to this grade will contribute to the welfare of the Society.
ASME Membership for attending an ASME Course or Conference!* Membership grades will be assigned based on information provided with this form. Additional information may be required for other grades.
Learn about ASMEs valuable Member Benefits at: www.asme.org/membership
Professional History
Instructions: Please complete all applicable fields on this writable .pdf form and return WHAT INTERESTS YOU? Choose up to eight: Select a code based on your Principal Job Function Select a code that best describes your Title
to ASME within 90 days after your course or conference via Email: customercare@ Connect with engineering professionals and participate in as many 01 General or corporate management Engineering
asme.org, Fax: 1-973-882-1717, or postal mail: ASME Service Center, 150 Clove interest groups as you would like from the list below. ASME groups allow 02 Product design, including applied research and development
Road, 6th Floor, Little Falls, NJ 07424-2100. For assistance completing this application, engineers and technical professional to receive relevant information and 31 Corporate V.P. for Engineering, Director, etc.
engage with others who share similar interests throughout the world. 03 Systems design, including applied research and development
please send questions to the email address above or call 1-646-616-3100 (Global) or 32 Chief Engineer, Senior Engineer, etc.
Indicate up to 8 selections. To become an online Participant in these and 13 Design of equipment for in-plant use
1-800 -THE-ASME / 800-843-2763 (U.S./Canada). 33 Project Manager
other groups beyond the available fields below, visit our website at
* One year free membership offer is only available only to ASME non-members taking an ASME 14 Other design engineering functions
www.asme.org/groups 34 Other (e.g. Engineer, Allied Scientist)
Public Course or attending an ASME Conference who have paid the full non-member rate. 04 Production engineering (processing or manufacturing)
05 Testing, reliability assurance, quality control, and standards
Non-Engineering
27 Advanced Energy Systems 13 Manufacturing Engineering 06 Plant engineering, operations, and maintenance
____________________________________________________________________ 35 President, Owner, etc.
11 Basic research & development
Name of ASME Course or Conference You Attended 01 Aerospace 10 Materials
15 Other process engineering functions 36 Vice President, Senior Manager, etc.
02 Applied Mechanics 29 Materials and Energy Recovery
____________________________________________________________________ 12 Consulting 37 Project Manager, Manager, or Supervisor
42 ASME International Outreach 04 Materials Handling Engineering
Last Name/Family Name 07 Education 38 Other (e.g., sales, marketing)
09 Bioengineering 39 Microelectromechanical Systems
M F 31 Computers & Information 41 Nanotechnology Institute 08 Other-please specify:___________________________________________
______________________________________ ___________ ______________
in Engineering
First Name/Given Name Initial Gender 32 Noise Control & Acoustics
14 Design Engineering
33 Nondestructive Evaluation, College(s) / University(ies) Attended Professional Record (attach resume or curriculum vitae)
____________________________________________________________________ 25 Dynamic Systems & Control Diagnosis, and Prognosis College/University Location Degree Area of Study Date of Degree
Birthdate MM / DD / YYYY (you must include exact birthdate with year) 44 Early Career (Connect) 17 Nuclear Engineering
Name of current
employer
45 ECLIPSE 35 Ocean, Offshore & Arctic
____________________________________________________________________ 34 Electronic & Photonic Packaging
Engineering
Job Title
Company 16 Petroleum
23 Environmental Engineering
40 Pipeline Systems Length of time in
____________________________________________________________________ 47 Engineers Without Borders current job years: months:
21 Plant Engineering & Maintenance
Primary (Mailing) Address Home Business 48 Entrepreneur's Network
19 Power
36 Fluid Power Systems & Technology 1. No Degree 2. B.A. 3. B.E. 4. B.S. 5. M.A. 6. M.S.
____________________________________________________________________ 08 Fluids Engineering
50 Pre-College
7. M.E. 8. Ph.D. 9. Sc.D. 10. Other (Describe)____________
(please attach additional sheet if more space is needed for address)
46 Grad Students
28 Pressure Vessels & Piping Reference Please complete to the best of your ability.
11 Heat Transfer
12 Process Industries Check box if your reference is an ASME Member
______________________________________ ___________ ________________
18 Rail Transportation
City State/Province Country 38 Information Storage & Professional Engineering Registration P.E. Name___________________________ Company__________________________
Processing Systems 07 Safety Engineering & Risk Analysis State/Country License No. Date of Issue
________________ __________________________________________________ 05 Internal Combustion Engine 30 Solar Energy Address________________________________ City_______________________
Zip/Postal Code Telephone w/area code Mobile Home Business 22 Intl Gas Turbine Institute 51 Student Liaisons
State/Province_____________ Postal code____________ Country_______________
49 Latin American Boiler Users Group 24 Technology & Society
___________________________ _______________________________________ 03 Management 15 Tribology Email _____________________________ Telephone_______________________
Email Address Fax Number (including area code)
43 Women in Engineering

(A) I authorize the Society to verify the information contained in this application and, to that end, to contact any educational institution, professional society, publisher, employer, or otherentity named
or identified in this application or in any document submitted in support of this application. I hereby consent to and authorize the release and disclosure to ASME of any information records or
correspondence as required to verify the information in the application, which is held by any such entity identified in this application. ASME Service Center 150 Clove Road, 6th Floor, Little Falls, NJ 07424-2100
(B) I subscribe to the above and, if elected to any grade, will be governed by the Constitution and By-Laws of the Society and its Code of Ethics as long as I continue as a member. I furthermore Phone: 1-646-616-3100 (Global)
agree to promote the objectives of the Society so far as shall be in my power. 1-800-THE-ASME/1-800-843-2763 (U.S./Canada)
Fax: 1-973-882-1717 Email: customercare@asme.org
8/2015
Please complete all sections on back side of application.
Market Code: PCCAPP16