NACE International Membership Application

New Renewal If renewing, would you like a new membership card? h yes h no PERSONAL & COMPANY DATA Please complete both your office and home addresses. First Name: Last (Family) Name: Company: Business Address: (Include mail stop) City: State/Province: Country: Business Phone: Business Fax: E-mail: Web Address: Home Address: (Include mail stop) City: State/Province: Country: Home Phone: Have you been a member of NACE previously? PROFESSIONAL INTERESTS
A Sex: Male Female B Education level: H High school diploma A Associates B Bachelors M Masters D Doctoral P Post-doctoral O Other_______________________________ (please describe) C Have you earned a Professional Engineers license? yes no D How did you hear about NACE? C Colleague A Advertisement E Education Course I Internet 1 NACE Catalog 2 NACE Journal 0 Other_______________________________ (please specify) E With regard to corrosion control products/services, I consider myself primarily a: U User/Consumer S Supplier/Producer B Both F My principal job function is: (Choose only one) 1 Management 2 Sales/Marketing 3 Engineer 4 Scientist/Researcher 5 Technician/Technologist 6 Professor/Teacher 7 Student 8 Consultant 9 Retired 10 Contractor 11 Inspector/QA/QC 12 Chemist 13 Designer/Architect 14 Maintenance 15 Purchasing 99 Other_______________________________ (please specify) G From the list below, choose the classification that best describes your companys function. (Choose only one) 5 Engineering/Architecture/Consulting Firms 6 Research Services 7 Chemical Processing/Process Industries & Allied Products 8 Aerospace 9 Pulp & Paper 11 Construction 12 Testing Services 13 Oil & Gas Extraction 14 Original Equipment Manufacturer 18 Coating & Lining Application 19 Coating & Lining Manufacturer/Distributor 21 Plastics/Nonmetals 23 Measuring, Analyzing & Controlling Instrumentation 27 Railcar/Tank Trucks 50 Metals/Mining 51 Ships/Marine Structures/Offshore Platforms 52 Oil & Gas Pipelines/Storage Tanks 53 Refining 54 Power Plant/Electric Utility 55 Bridges & Highways 56 Municipal Water Distribution/Treatment 57 Industrial Water Treatment 140 Other_______________________________ (please specify) H Technologies I use in my job: 0 Cathodic/Anodic Protection 1 Chemical Process 2 Coatings and Linings 3 Inhibitors 4 Materials SelectionMetals 5 Materials SelectionNonmetals 6 Design 7 Testing & Monitoring 8 Other_______________________________ (please specify) I Birthdate ________ / ________ / ________ MM DD YY

Where do you want information mailed?

Office

Home

Zip/Postal Code:

(Include area code for U.S. and country/city codes for international) (Include area code for U.S. and country/city codes for international)

Zip/Postal Code:

(Include area code for U.S. and country/city codes for international) Yes No If yes, NACE member #

1A0611

OPTIONS OF MEMBERSHIP AND SERVICES Individual Membership Individual Membership with Corrosion journal $215 only includes access to the online journal $235 includes both the printed and online journal Librarians representing an institution or library (academic, corporate, private, public, etc.) must pay the institution rate. Corporate Member The person named on this application is the primary representative h Platinum Corporate Member h Gold Corporate Member h Silver Corporate Member h Bronze Corporate Member h Nickel Corporate Member For further information, please contact the NACE International Corporate Membership Specialist at: Phone: +1 281-228-6271 Fax: +1 281-228-6371 Online: www.nace.org/memberbenefits Membership Certificate NACE Foundation Donation h $25 h $50 h $75 NACE Foundation of Canada Donation h $25 h $50 h $75 h $100 h Other h $100 h Other

AMOUNT 1 YEAR $130 $215 $235 2 YEARS $250 $420 $450

TOTAL

$5,000 $3,500 $1,500 $1,000 $500

$15 $______

NACE Foundation donations sustain the independent NACE Foundation. The NACE Foundation works with schools and universities to advance corrosion education and support such activities as education outreach programs and scholarships for deserving students. U.S. donations are tax-deductible to the full extent of the law. Contributions may not be tax-deductible outside of the U.S.; therefore, review your local tax laws. For information, contact the NACE Foundation at +1 281-228-6205 or visit www.nace-foundation.org. Donationinhonor/memoryof:___________________________________________________________ Add dues and options to calculate total amount to be paid.
Membership dues are nontransferable and nonrefundable. Membership benefits are nontransferable. Amount paid

PAYMENT OPTIONS Payments can be made by check, money order, or credit card in U.S. funds made payable to NACE. $12 of membership dues (not deductible) is for a Materials Performance subscription. For faster processing, consider paying by credit card and faxing this form to NACE at +1 281-228-6329 or join online at www.nace.org. h Check/money enclosed: U.S. $ h Credit card payment h MasterCard h VISA Check number: h American Express h Discover Promo code:

Account number: Expiration date: Name as it appears on card: Signature:

For more information, contact NACE FirstService at 1 800-797-6223 (U.S. & Canada) or +1 281-228-6223 (Outside the U.S. & Canada).

Mail completed application with payment to: NACE International 1440 South Creek Dr Houston, TX 77084-4906 USA
1A0611