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The Canadian Society for Civil EngineeringLa Société canadienne de génie civi l
C SCECGC 1887
A Member Society of The Engineering Institute of Canada / Une Société adhérente de l’Institut canadien des ingénieursNational Headquarters: Suite 201, 4920 de Maisonneuve Blvd. West, Montreal, Quebec H3Z 1N1
Tel. : (514) 933-2634 Fax : (514) 933-3504 E-mail: [email protected] Web: www.csce.ca
APPLICATION FOR ADMISSION AS STUDENT MEMBER OCTOBER 1ST TO SEPTEMBER 30TH
UNDERGRADUATE GRADUATE
PLEASE TYPE OR PRINT CLEARLY
M E-MailTel.: ( )
SURNAME (LAST NAME)
UNIVERSITY ATTENDING
GIVEN NAME (UNDERLINE NAME USED)
DISCIPLINE
YEAR OF BIRTH
EXPECTED YEAR OF GRADUATION
MEMBERSHIP YEARHAVE YOU EVER BEEN A CSCE MEMBER?
IF YES, MEMBERSHIP NUMBER (IF KNOWN)YES NO
19
20
20
Please indicate desired mailing address and advise the CSCE Headquarters promptly of any address change. Publications will be sent tothis address until such notification is received.
Student Members may be registered in three Divisions. Please indicate in order of preference (1, 2, 3)
PLEASE NOTE : Annual Fees must be forwarded with this Application, Cheque to be made to the Canadian Society for Civil Engineering.
SIGNATURE OF APPLICANT
Signature
Date
Your Student Membership entitles you to participate in any of the Society’s national, regional, or local activities, as well asyour own Student Chapter activities. Your membership fee also covers your subscription to the Canadian Civil Engineer.
Dues payment
30. Structural 31. Hydrotechnical 32. Environment
33. Transportation 36. Computer Applications 37. Construction
38. Engineering Materials / 40. Cold Region Engineering 41. Sustainable Development
42. Infrastructure Renewal
No. Street Apt.
City Province Postal Code
No. Street Apt.
City Province Postal Code
PRESENT ADDRESS PERMANENT (HOME) ADDRESS
$
CSCE REPRESENTATIVE ENDORSEMENT
Signature
Date
FRANÇAIS AU VERSO
*
**
*
*
**
*
*
: REQUIRED
Mechanics
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