Application for SSRC Membership
Name
*
First Name
Last Name
Organization
*
(Academic Institution, Company, Trade Association, Institute, Society, Other)
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Highest degree obtained
*
Engineering Registration/Licensure
*
Email
*
example@example.com
Phone Number
*
-
Country Code
-
Area Code
Phone Number
Attach CV/Resume
*
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Preferred Membership Level
Euler Society ($2,400+)
Johnston Society ($900-$2,399)
Shanley Society ($600-$899)
Beedle Society ($300-$599)
Winter Society ($120-$299)
Member-at-Large MAL ($70)
Student Member ($20)
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