ENGINEERING SOCIIETY OF WESTERN MASSACHUSETTS

Application for Membership

To the Executive Board:

           I, __________________________________________________________  
                               (Please print or type your full name)

hereby apply for membership in the Engineering Society of Western Massachusetts on the basis of my professional experience and/or my interest in furthering the engineering profession. The below named Engineering Society member is personally familiar with my work and is sponsoring my application.

I certify that if elected to membership in the Engineering Society of Western Massachusetts, I will be governed by the Bylaws of the Society and will promote the objects of the Society insofar as I am able.

                                  Respectfully,

                        _________________________________________________  
                                                     (Signature of Applicant)

Present occupation/title ____________________________________________________

Employer ______________________________________________________________

Business Address ________________________________________________________

_____________________________Business phone _____________________________

Home address___________________________________________________________

_______________________________Home phone_____________________________

Education _________________________ __________________ __________________
                      (School or College)                         (Degree)                  (Graduation Date)

Send Mail to: ( ) Home Address ( ) Business Address  

REFERENCES

The reference should be personally acquainted with the applicant and believe that his or her membership will be beneficial to the Society and the engineering profession.

1. Name (please print or type) ______________________________________________

2. Name (please print or type) ______________________________________________

Please submit this completed Application, along with $5.00 Entrance Fee and $25.00 dues for the first year, to

Treasurer, ESWM, PO Box 366, East Longmeadow, MA 01028-0366.