Philadelphia – Delaware Valley Chapter
Membership Application
Name
and Professional Designation:
Please
indicate by a checkmark where
you prefer to receive your meeting notices.
It is to our advantage to use Email, if possible.
Business Phone Number:
Business Fax Number:
Home Phone Number:
Home Fax Number:
Home Email Address:
Professional Data:
Education - Name of Colleges/Technical Schools, Degree(s)/Major & Dates Graduated
Professional & Business Experience:
Are you a Registered Professional Engineer?
Professional Credentials:
Please
indicate:
Membership status with SFPE
National, if any Membership No.
Other Professional Society Memberships
Other Professional Credentials: NICET Level CFPS
The undersigned, in
making application for membership in the Philadelphia-Delaware Valley Chapter
of the Society of Fire Protection Engineers certifies that all statements and
answers included herein are true in substance and effect, and are made in good
faith.
Signature of Applicant ________________________________ Date
__________
Entrance Fee: $15.00 to be included with this application. If this application is not accepted, the fee will be returned. If accepted, annual dues will be due again in September.
(Make check payable to: SFPE –
Philadelphia-Delaware Valley Chapter)
Please
return this form and check to: M.
G. Top Myers, SFPE Treasurer
961 Pottstown Pike
Chester Springs, PA 19425
800-874-5880, x219 Fax 610-321-1011
tmyers@microtrack.com