This application is for:
MSAMP Member
Honorable Discharge Date:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
2016
2017
2018
2019
2020
NOTE: You MUST
email or fax (+1.304.291.5728) us documentation
indicating your honorable discharge! Your application will not be processed, until this
information is received in our office. Also, MSAMP members will
receive an electronic subscription to the CE Journal.
General Information:
Prefix: Mr. Ms. Dr. Select
Note: Please enter your name below as you wish it to appear on your membership card.
First Name:
Middle Name:
Last (Family Name):
Suffix:
Date of Birth:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
,
Year
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
1969
1968
1967
1966
1965
1964
1963
1962
1961
1960
1959
1958
Gender/Sex:
Male
Female
Contact Information:
You must
enter a mailing address, phone and email address for
either your business OR home.
Business:
Company Name:
Job Title:
Mailing Address:
Physical Address:
(if different from mailing)
City:
State/Province:
Postal Code:
Country:
Telephone:
Fax:
Email:
Home:
Mailing Address:
Physical Address:
(if different from mailing)
City:
State:
Postal Code:
Country:
Telephone:
Fax:
Email:
Preferred/Default Contact Method:
Mail:
Business
Home Publish in Directory?
Yes
No
Phone:
Business
Home Publish in Directory?
Yes
No
Fax:
Business
Home Publish in Directory?
Yes
No
Email:
Business
Home Publish in Directory?
Yes
No
I do NOT want my name to be released for commercial mailings or email lists.
Background Information:
Education:
College/University:
City, State/Province, Country:
Degree and Major:
Date Received:
Month
January
February
March
April
May
June
July
August
September
October
November
December
In Progress
Year
In Progress
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
College/University:
City, State/Province, Country:
Degree and Major:
Date Received:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
In Progress
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
Work Experience: (if
applicable)
From:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
To:
Month
Present
January
February
March
April
May
June
July
August
September
October
November
December
Year
Present
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
Job Title:
Company Name:
Supervisor:
Job Duties:
From:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Year
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
To:
Month
January
February
March
April
May
June
July
August
September
October
November
December
Current
Year
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
1979
1978
1977
1976
1975
1974
1973
1972
1971
1970
Job Title:
Company Name:
Supervisor:
Job Duties
Referred by:
Member Number:
Name:
Dues Information:
Select Month of application:
<
Select month of Application
January - US$0.00 (ends December 31 this year)
February - US$0.00 (ends December 31 this year)
March - US$0.00 (ends December 31 this year)
April - US$0.00 (ends December 31 this year)
May - US$0.00 (ends December 31 this year)
June - US$0.00 (ends December 31 this year)
July - US$0.00 (ends December 31 this year)
August - US$0.00 (ends December 31 this year)
September - US$0.00 (ends December 31 this year)
October - US$0.00 (ends December 31 next year)
November - US$0.00 (ends December 31 next year)
December - US$0.00 (ends December 31 next year)
Local Section Dues:
You must choose a Local Section.
Local Section:
Not Selected
USA - ALABAMA - US $0.00
USA - ALASKA - US $0.00
USA - ARIZONA - US $0.00
USA - CALIFORNIA San Francisco Bay Area - US $0.00
USA - CALIFORNIA South Central California - US $0.00
USA - CALIFORNIA Southern California - US $0.00
USA - COLORADO Rocky Mountain - US $0.00
USA - CONNECTICUT (Nutmeg) - US $0.00
USA - DELAWARE Valley - US $0.00
USA - DISTRICT OF COLUMBIA Baltimore Metro - US $0.00
USA - DISTRICT OF COLUMBIA National Capital - US $0.00
USA - FLORIDA Greater Miami - US $0.00
USA - FLORIDA North Florida - US $0.00
USA - GEORGIA Atlanta Area - US $0.00
USA - GEORGIA Central Savannah River Area - US $0.00
USA - HAWAII - US $0.00
USA - IDAHO Snake River - US $0.00
USA - ILLINOIS Chicago-Midwest - US $0.00
USA - INDIANA Indiana Hoosier - US $0.00
USA - KANSAS City - US $0.00
USA - KENTUCKY Tri-States - US $0.00
USA - LOUISIANA Greater New Orleans - US $0.00
USA - MARYLAND Baltimore Metro - US $0.00
USA - MARYLAND National Capital - US $0.00
USA - MASSACHUSSETS New England-Boston - US $0.00
USA - MICHIGAN Great Lakes - US $0.00
USA - MISSOURI Kansas City - US $0.00
USA - MISSOURI St. Louis - US $0.00
USA - NEVADA (Las Vegas) - US $0.00
USA - NEW JERSEY Delaware Valley - US $0.00
USA - NEW JERSEY - US $0.00
USA - NEW MEXICO - US $0.00
USA - NEW MEXICO Valle Grande - US $0.00
USA - NEW YORK Genesee Valley - US $0.00
USA - NEW YORK Metropolitan New York - US $0.00
USA - NEW YORK Niagara Frontier - US $0.00
USA - N. CAROLINA Catawba Valley (Charlotte, NC) - US $0.00
USA - N. CAROLINA (Raleigh-Durham) - US $0.00
USA - OHIO Northeast Ohio - US $0.00
USA - OHIO Southwestern Ohio - US $0.00
USA - OHIO Tri-States - US $0.00
USA - OKLAHOMA Northeast Oklahoma - US $0.00
USA - OREGON Cascade - US $0.00
USA - PENNSYLVANIA Delaware Valley - US $0.00
USA - PENNSYLVANIA Pittsburgh - US $0.00
USA - S. CAROLINA UpCounty - US $0.00
USA - S. CAROLINA Central Savannah River Area - US $0.00
USA - TENNESSEE East Tennessee - US $0.00
USA - TENNESSEE Tennessee Valley - US $0.00
USA - TENNESSEE University of Tennessee - US $0.00
USA - TEXAS Central Texas - US $0.00
USA - TEXAS Dallas-Ft. Worth - US $0.00
USA - TEXAS Houston Gulf Coast - US $0.00
USA - TEXAS Palo Duro Canyon Section - US $0.00
USA - UTAH Section - US $16.50
USA - VIRGINIA Central Virginia - US $0.00
USA - VIRGINIA National Capital - US $0.00
USA - WASHINGTON Rattlesnake Mountain - US $0.00
USA - WASHINGTON Seattle - US $0.00
USA - WASHINGTON Spokane - US $0.00
USA - WASHINGTON University of Washington - US $0.00
USA - WEST VIRGINIA Northern West Virginia - US $0.00
USA - WEST VIRGINIA Tri-States - US $0.00
USA - WISCONSIN - US $0.00
CANADA - ALBERTA Aurora-Edmonton - US $0.00
CANADA - ALBERTA Chinook-Calgary - US $0.00
CANADA - ALBERTA Fort McMurray - Northern LIghts - US $0.00
CANADA - BRITISH COLUMBIA - US $0.00
CANADA - MANITOBA Keystone - US $0.00
CANADA - ONTARIO Bluewater (Sarnia) - US $0.00
CANADA - ONTARIO Toronto - US $0.00
CANADA - QUEBEC Montreal - US $0.00
AUSTRALIA - Victoria - US $0.00
CARIBBEAN - US $0.00
EGYPT - Greater Cairo - US $0.00
INDIA - Central India - US $0.00
INDIA - North India - US $0.00
INDIA - South India - US $0.00
JAPAN - US $0.00
JORDAN - US $0.00
KOREA - US $0.00
KUWAIT - US $0.00
LEBANON - US $0.00
MALAYSIA - US $0.00
NIGERIA - US $0.00
NORWAY - US $0.00
OMAN - US $0.00
PAKISTAN - US $0.00
PUERTO RICO - US $0.00
RUSSIA - Greater Russia - US $0.00
RUSSIA - Moscow - US $0.00
SAUDI ARABIA - Arabian Gulf - US $0.00
SIGNAPORE - US $0.00
UKRAINE - Chornobyl - US $0.00
UAE - US $0.00
CYBERSECTION - US/CANADA - US $0.00
CYBERSECTION - INT'L (NOT US)- US $0
Comments or Questions:
If you have any comments or questions
associated with your application, please enter them in the field below.
Also, please use this space to enter any special promotional discount codes:
By submitting this application, I agree
to abide by the Constitution and
Bylaws and Canons of Ethics of AACE International.