Student Membership Application Form

Fields with an asterisk ( * ) are required.

Personal Information

* Prefix: (Mr., CAPT, Maj., etc.)

* First Name: MI:

* Last Name: Suffix (Jr., P.E., etc.)

* Post Affiliation:
Post 1:
Post 2:

Contact Information

Home Address (required)

*Street Address:
*City:
*State/Province/APO/
U.S. Territory:
*ZIP/Postal Code:
Country NON-US ONLY
Home Phone:

School Address (optional)

Street Address:
City:
State/Province/APO/
U.S. Territory:
Zip or Postal Code:
Country NON-US ONLY
Alternate Phone:
*E-Mail Address:

Graduation Date

You must enter a graduation year in order to qualify for a student membership. Once you have graduated, you will receive a renewal notice to join SAME as a fully paid member.

*School or Institution Name:
Are you a Faculty Advisor? Yes
Sex: Male Female *Graduation Year: [YYYY]
*Birth Date Valid date format: mm/dd/yyyy

Please report membership problems to the Membership Department at member@same.org.