Structural Engineers
Association of Nebraska
(SEAON)
MEMBERSHIP APPLICATION (Period June 1, 2011 - May 31, 2012)

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* REQUIRED

NAME *
TITLE *
COMPANY *
MAILING ADDRESS *
CITY/STATE *
ZIP *
BUSINESS PHONE: *
HOME PHONE:(optional)
FAX: (optional)
EMAIL *

Licensing Status *	P.E. F.E.(E.I.T) S.E. Other/None


MEMBERSHIP GRADE *	Professional Member Licensed or registered Professional Engineer actively engaged in the practice of Structural Engineering.

	Associate Member E.I.T. engaged in the practice of Structural Engineering who is not professionally licensed.

	Affiliate Member Non-engineer interested in the practice of Structural Engineering and qualified to assist in the advancement of professional knowledge, practice and welfare.

	Student Member Full or part-time student (9 hrs. min.) pursuing a degree course in Civil, Architectural or Structural Engineering.


COMMITTEE PARTICIPATION *	Would you like SEAON to contact you in regards working on a committee?
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DUES *	Member $70 Student $20

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