free-cc-app-student

Student Membership Activation Form for ASME
Non-Member Course & Conference Aendees
THE AMERICAN SOCIETY OF MECHANICAL ENGINEERS
Complete and return this form to ASME within
60 days for your one year introductory
Membership at no cost.
Congratulations, you are eligible to receive One Year of ASME Student
Membership at no cost for attending an ASME Course or Conference!*
Instructions: Please complete all applicable fields on this writable .pdf form and return
to ASME within 60 days after your course or conference via Email: customercare@ asme.org, Fax:
1-973-882-1717, or postal mail: ASME Service Center, 150 Clove Road, 6th Floor, Little Falls,
NJ 07424-2100. For assistance completing this application, please send questions to the email
address above or call 1-646-616-3100 (Global) or 1-800 -THE-ASME / 800-843-2763
(U.S./Canada).
* One year no cost membership offer is only available to ASME non-members taking an ASME
Public Course or attending an ASME Conference who have paid the full non-member rate.
____________________________________________________________________
Name of ASME Course or Conference You Attended
Last Name/Family Name
M  F _______________________
_____________________________ _____ 
______
Initial
Gender
Birthdate MM / DD / YYYY
(must include exact birthdate
with year_________________
to be processed)
___________________________________________________
(Attach separate sheet if you need
Current Street Address On Campus Off Campus
more room for your address)
______________________________________ ___________ ________________
City
State/Province
Country
___________________________ _______________________________________
Zip/Postal Code
WHAT INTERESTS YOU? • Choose one:
Connect with engineering professionals by choosing a Technical Division/
Interest Groups from the list below. These ASME groups allow
engineering students, engineers and technical professionals to receive
relevant information and engage with others who share similar interests
throughout the world.
27 Advanced Energy Systems
01 Aerospace
____________________________________________________________________
First Name/Given Name
View all of ASME’s Student Member Benefits
at: http://go.asme.org/students
Telephone Number (including area code)
____________________________________________________________________
Permanent Street Address (where you can be reached for the next 5 years)
______________________________________ ___________ ________________
City
State/Province
Country
___________________________ _______________________________________
Zip/Postal Code
Telephone Number (including area code)
Send mail to: Current Address Permanent Address
____________________________________________________________________
E-Mail Address
I am a: 1st yr/Freshman 2nd yr/Sophomore 3rd yr/Junior 4th yr/Senior Graduate
I am currently seeking the following degree: (check one)
BA BE BS MA ME MS PhD ScD Other (Describe)___________
______________________________________ ____________________________
Name of University
Scheduled date of Graduation ________ /________
MM
YY
Campus
(application must include approximate
date of graduation to be processed)
__________________________________________________
Applicant Signature
___________
Date
04 Materials Handling
Engineering
02 Applied Mechanics
39 Microelectromechanical
Engineering
09 Bioengineering
32 Noise Control & Acoustics
31 Computers & Information in
Engineering
33 Nondestructive Evaluation,
Diagnosis, and Prognosis
14 Design Engineering
17 Nuclear Engineering
25 Dynamic Systems & Control
35 Ocean, Offshore & Arctic
Engineering
34 Electronic & Photonic
Packaging
16 Petroleum
23 Environmental Engineering
40 Pipeline Systems
36 Fluid Power Systems
& Technology
21 Plant Engineering
& Maintenance
08 Fluids Engineering
19 Power
11 Heat Transfer
28 Pressure Vessels & Piping
38 Information Storage &
Processing Systems
12 Process Industries
05 Internal Combustion Engine
18 Rail Transportation
22 Int’l Gas Turbine Institute
07 Safety Engineering &
Risk Analysis
03 Management
30 Solar Energy
13 Manufacturing Engineering
24 Technology & Society
10 Materials
15 Tribology
29 Materials and Energy Recovery
Personal Information Disclosure
ASME uses your personal information to process the membership application,
determine membership type and eligibility for individual member services, and to
provide access to member benefits. We also use your personal information to
identify and notify you of new or existing member benefits and services and/or
tailoring the membership package based on your member profile and information.
ASME will transfer your personal information to third-party providers of member
benefits for the purposes of enrollment and access to the benefits to which you are
entitled as a member of ASME. By submitting this application you are providing
consent to use your information for the purposes previously described herein.
Please review the ASME Privacy Statement at: go.asme.org/privacy
ASME Service Center
150 Clove Road, 6th Floor, Little Falls, NJ 07424-2100
I subscribe to the above record and when elected will be governed by the Constitution and
By-Laws of the Society and its Code of Ethics as I continue as a member. I furthermore
agree to promote the objectives of the Society where possible.
Phone: 1-646-616-3100 (Global)
1-800-THE-ASME/1-800-843-2763 (U.S./Canada)
Fax:
1-973-882-1717
_________________________________________________________________
ASME Student Section Advisor’s Signature (or Dept. head/Dean)
Email: [email protected]
4/2019
Market Code: SCCAPP19