2023-24 SEAMASS Member or Sponsor RENEWAL Registration

Personal Information

• All new members must provide this brief info, to help SEAMASS update the Member Roster that we provide to our national organization, NCSEA.

• Prefix: --Choose-- Mr Mrs Miss Ms Dr Prof Rev Fr Sr Rabbi
• * First Name:
• * Last Name:
• * Email Address:
• * Confirm Email Address:
• Company Name
• Mailing Address (to receive STRUCTURE Magazine)
• * City:
• * State: --Choose-- Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming -------------- Alberta British Columbia Manitoba New Brunswick Newfoundland and Labrador Northwest Territories Nova Scotia Nunavut Ontario Prince Edward Island Quebec Saskatchewan Yukon Territory
• * ZIP Code:
• * Phone:

• Fee

  Type	Fee
  Prof. Member Renewal (thru May 2024)	$75.00
  Assoc. Member Renewal (thru May 2024)	$75.00
  Student Member Renewal (thru May 2024)	$25.00
  Prof. or Business Sponsor Renewal (incl. 1 membership) thru Aug 2024	$350.00
  Corp. Sponsor Renewal (includes up to 6 memberships) thru Aug 2024	$1,200.00

Custom Information 1

• Professional Status (PE, EIT, SE, etc.)
• Job Title

• Are you Young Member Group (YMG)-Eligible/Interested?

  • Yes
  • No

Associate Information

You may add a maximum of 10