of
Fire Protection System Designers
APPLICATION FOR MEMBERSHIP
NAME _________________________________________________________________________________
ADDRESS ______________________________________________________________________________
CITY, STATE, ZIP _______________________________________________________________________
EMPLOYER _____________________________________________________________________________
ADDRESS _____________________________________________________________________________
CITY, STATE, ZIP _______________________________________________________________________
PHONE: WORK _________________________________
HOME __________________________________
FAX: ____________________________ PREFERRED
MAILING ADDRESS - HOME _______ OFFICE______
NICET CERTIFIED? Yes _______ No
______ ASCET NATIONAL MEMBER? Yes _______ No _______
PROFESSIONAL ENGINEER ? Yes
________ No _______
E-MAIL ADDRESS _______________________________________________________
MEMBERSHIP CATEGORIES (circle one)
CERTIFIED MEMBER - Persons
holding certificate by board approved certification agency. Dues $50.00
REGULAR MEMBER - Engineering technicians with minimum of two years of engineering technology experience:
or, a two or four year degree from accredited engineering program. Dues
$50.00
ASSOCIATE MEMBER - Persons
with less than two years of engineering technology experience. Dues $50.00
REGISTERED MEMBER -
Professional Engineers. Dues $50.00
SUSTAINING/CORPORATE MEMBER - Dues $250.00
Make checks payable to NEAFPSD and mail to:
NEAFPSD, PO Box 149 Wrentham, MA 02093-0149