Individual Membership

Title

Mr.

Mrs.

Ms.

Dr.

Prof.

Other.

Business Title

Last Name
First Name
Middle Name
Suffix

YES! I would like to join the Environmental & Water Resources Institute.

I am currently a member of ASCE and wish to select EWRI as my primary Institute at no additional cost.
*ASCE Member ID *Must provide if currently an ASCE member

I am currently a member of ASCE and SEI/G-I/AEI and wish to join EWRI as an additional Institute.

I would like to join EWRI only.

I would like to join EWRI as a student.

Personal Information (Complete this section if you are not already an ASCE member or if you want to correct ASCE Membership data) Residence

Address
City	State	Zip
Country
Phone #

Business

Name of Employer
Address
City	State	Zip
Country
Phone #
Fax #
E-mail

Please Click Below Your Preferred Mailing Address:

Residence

Business

Date of Birth Social Security #

Business/Position Category Type of Business

Consulting		Consulting Engineering Firm, Engineer in Private Practice

Contractor		Contractor

Government		Federal
		Regional Authority
		State
		Municipal, County, Township & District
		Foreign

Industry/Utility		Commercial and/or Industrial Organizations (including transportation and privately owned utility companies)
		Producer of Construction Materials
		Manufacturer of Equipment and Supplies

Education		Student
		Educator, Professor, Instructor
		Special Interest Organization, Association
		Other

Educational Information Please use appropriate abbreviations when possible. Please list all degrees received or being pursued, using appropriate abbreviations (i.e., BSCE, MSCE, Ph.D., MBA, MSEM)

College/ University	Dates Attended/ Attending	Degree/ Major	Graduation Date

Professinal/Work Experience
You may paste a recent resume in lieu of completing this section.

Name of Employer & Name, Title of Supervisor	Length of Employment	Position Description/ Assignment
	Years Months
	Years Months
	Years Months

How many years have you participated in the environmental and water resources industry?
Please provide a brief statement describing your participation in the environmental and water resources industry.

Professional Licenses and Associations Please list professional licenses and professional association affiliations:

Payment Information and Signature

Membership Category	Qualifications	Total Due
ASCE and EWRI Joint Membership ($200)	Membership materials for ASCE will be forwarded to you.	$
EWRI Membership as an Additional Institute ($20)	For current members of ASCE and SEI, G-I, or ARI - Institutes of ASCE.	$
EWRI-Only Membership ($85)	For individuals engaged in the development of policies and programs related to water resources and the environment including the planning, design, construction, operation, management, and regulation of associated engineered works	$
Student ($0)	For full-time students interested in the environmental or water resources field of practice	$

*Annual dues do not need to be included with your application. You will be invoiced for dues once your application has been processed. FAx your completed application to 703-295-6333 or mail to ASCE-EWRI MEMBERSHIP, 1801 Alexander Bell Drive, Reston, VA 20191-4400 USA

I authorize the Institute to verify the information contained in this application and, to that end, to contact any educational institution, professional society, publisher, employer, or other entity named or identified in this application or in any document submitted in support of this application. I hereby consent to and authorize the release and disclosure to the Environmental and Water Resources Institute of any information, records or correspondence as required to verify the information in the application, which is held by any such entity identified in this application.

Date: