NSTEM Member Application

NSTEM Member Application
Member Information
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Email (only if age 13 and over)
example@example.com
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Current Grade Level
Is the applicant 13 years old or above?
Why are you interested in becoming a member of NSTEM and what STEM related activities do you engage in both in and out of school? (Include mathematics, science, CTE, etc. classes)

Membership Authorization
Name of Applicant

First NameLast Name
Name of applicant: Insert Name National STEM Honor Society (NSTEM) requires that the following Membership Authorization be signed by a parent/guardian if the Applicant is under the age of 18, or by the Applicant if 18 or over. If this Membership Authorization is not signed, or is signed but is modified, the Applicant will not be eligible to be a member of NSTEM.

If the Applicant is under the age of 13, the parent/guardian may withdraw consent at any time to NSTEM collecting personal data of the Applicant via the internet and using such data by contacting NSTEM. In such case, the Applicant will not be able to continue as a student member of NSTEM.
I am the (check one)
I, Insert Name certify that I have reviewed the information provided in the completed application form, and hereby: 1. consent to the Applicant participating as a student member in the National STEM Honor Society (NSTEM) and providing the information in this application to NSTEM; 2. grant to NSTEM, the Chapter Advisor, and other persons acting for or through NSTEM, the right to collect personal information about the Applicant, via the internet or otherwise, and if applicable share it with NSTEM for use by NSTEM in the operation of the NSTEM program as further described in the NSTEM Privacy Policy; and 3. authorize NSTEM to send me electronic copies of the NSTEM newsletters, and emails, and acknowledge that I can unsubscribe from receiving them at any time. I hereby assume full legal responsibility for the consents and authorizations given above.
Signature

Membership Fee
My Products
prevnext( X )
NSTEM Membership Fee
$25.00 Quantity

Total

$0.00
Payment Methods

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NSTEM Member Application

Member Information

Parent / Guardian Information

Demographic Information

Membership Authorization

Membership Fee

My Products

Payment Methods