Join ASSE

Please indicate a Chapter Affiliation and a Membership Classification:

Half-Price Membership Dues for the first year (for new Active Members only)!

Membership Classification (choose one):	Active	Retired	Student	Government	Lab	Sustaining
Arizona Chapter (Phoenix)	$85	$35	$25	$60	$950	$300
California Chapter (Los Angeles)	$85	$35	$25	$60	$300	$300
Northern California Chapter (San Jose)	$85	$35	$25	$60	$300	$300
Florida Chapter (Dade County area)	$85	$35	$25	$60	$300	$300
Georgia Chapter (Atlanta)	$95	$40	$50	$60	$300	$300
Illinois Chapter (Chicago)	$85	$35	$30	$65	$300	$300
Louisiana Chapter (New Orleans)	$105	$50	$25	$75	$300	$300
Member-at-Large (no nearby chapter)	$85	$35	$25	$60	$300	$300
Michigan Chapter (Detroit)	$95	$35	$25	$75	$300	$300
Minnesota Chapter (Minneapolis)	$85	$35	$25	$60	$300	$300
Missouri Chapter (St. Louis)	$90	$35	$25	$60	$300	$300
New York Chapter (New York City)	$125	$35	$25	$85	$300	$300
Central Ohio Chapter (Columbus)	$85	$35	$25	$60	$300	$300
Northern Ohio Chapter (Cleveland)	$100	$35	$25	$60	$300	$300
Southern Ohio Chapter (Cincinnati)	$90	$45	$40	$70	$300	$300
Oklahoma Chapter (Tulsa)	$100	$35	$25	$60	$300	$300
Pacific Northwest Chapter (Oregon)	$85	$35	$25	$60	$300	$300
Northeastern Pennsylvania Chapter (Scranton)	$85	$35	$25	$60	$300	$300
Pennsylvania Chapter (Philadelphia)	$85	$35	$25	$60	$300	$300
Rocky Mountain Chapter (Colorado)	$85	$35	$25	$60	$300	$300
Texas Chapter (Dallas)	$85	$35	$25	$60	$300	$300
Texas Gulf Coast Chapter (Houston)	$90	$35	$25	$60	$300	$300
Wisconsin Chapter (Milwaukee)	$85	$35	$25	$60	$300	$300
International Chapter (Foreign Members)	$120	-	-	-	$300	$300

Name:
Company:
Address:Company Home
City: State: Zip:
Phone: Fax:
E-Mail:
Website:
Occupation or Position:
Firm:
Type of Business:
Education - Degree:
Technical:
Sponsor (if any):

The Applicant agrees that the above statements are correct; and agrees if admitted to the Society that he will be governed by its rules as long as his membership shall continue; that he will promote the objectives of the Society as far as shall be in his power; and in case of his reversing his membership, he will return his membership certificate and card. I Agree I do NOT Agree

Method of Payment

To pay online by credit card (Visa, MasterCard, and American Express) please be sure to include the following credit card information.

If you wish to pay by check, please complete the payment information at the bottom & mail to ASSE along with a completed application form.

*Visa MasterCard AMEX *Exp date:/
*Credit Card Number: **CVN:

*Name as on card:
*Billing Address:

*Required fields for all credit card payments.

**Required. The Card Verification Number (CVN). On Visa and MasterCard, the CVN is a 3-digit number on the back following the card number on the signature strip. On AMEX cards, the number is a 4-digit number on the front.

NOTE: For check payment, please complete the following information
Check #