SMPE Membership Application

APPLICATION FOR MEMBERSHIP

THE SOCIETY OF MARINE PORT ENGINEERS, NEW YORK, NY

P.O. Box 369 - Eatontown, NJ - Phone (732) 389-2009 - Fax (732) 389-2264

The undersigned respectfully represents that he holds a license or degree in good standing and petitions for membership as:

FULL MEMBER

ASSOCIATE MEMBER

PERSONAL DATA

FULL NAME
ADDRESS
CITY	STATE	POSTAL CODE
TELEPHONE
FAX
EMAIL
PLACE OF BIRTH		DATE OF BIRTH

PROFESSIONAL DATA

COMPANY
POSITION
ADDRESS
CITY	STATE	POSTAL CODE
TELEPHONE		FAX
EMAIL
WEB SITE URL

EDUCATIONAL AND LICENSE INFORMATION

SCHOOL OR COLLEGE		DATE OF GRADUATION
LOCATION
DEGREE
LICENSE	TONNAGE	DATE ISSUED
SERIAL NO.	ISSUE NO.
** COPY OF LICENSE AND OR DEGREE TO BE SUBMITTED BY MAIL WITH THIS FORM **

MISCELLANEOUS INFORMATION

NAVAL RESERVE STATUS
MARITIME SERVICE STATUS
OTHER ENGINEERING OR SOCIETY ATTAINMENTS

SPONSORS

**This application must be signed by sponsors who are presently members of the Society and in good standing. If this application is submitted online please list sponsors and there phone numbers.**
SPONSOR'S NAME		TELEPHONE NO.
SPONSOR'S NAME		TELEPHONE NO.

****This application can be filled in online, printed by the applicant and mailed along with a check for membership initiation fee of $50.00, refundable if applicant is rejected. Dues of $100.00 per year, payable in advance upon notification of acceptance. Also after completion of this form it may be submitted electronically by clicking on the below submit button to commence acceptance procedures. Final acceptance will be made when all applicable information, including sponsor signatures and application fee is received by mail.****

I, the petitioner, whose signature is affixed hereto being duly acquainted with the high aim and purpose of this society to further the development and progress of the American Merchant industry and to elevate the business and professional standing of the Marine Port Engineer, knowing of no physical, legal or moral reason why I should not participate in this forward movement also declare that I am familiar with the by-laws of the Society which I will strive to uphold to the best of my ability if accepted, do respectfully submit my qualifications for consideration to election to membership in this honorable body.

Applicant's Signature		Date