Membership Form

SEAM Membership Online Form 2018
Welcome to our online 2018 membership form. Please fill out responses as appropriate. After you submit the form, you will be redirected to a payments page.
* Required
Last Name *
Enter your last name
Your answer
First Name *
Enter your first name
Your answer
Middle Initial *
Your answer
Employer or Affiliation *
Enter your Employer or Organization
Your answer
Address *
Address Business/Home/Organization/University
Choose
Business
Home
Organization
University
Street or P.O. *
Please enter your street address
Your answer
City *
Please enter your city
Your answer
State *
Please enter your state
Your answer
Zip Code *
Please enter your zip code
Your answer
Phone Number *
Please enter your preferred phone number
Your answer
Fax Number
Please enter your fax number
Your answer
Company Website
Please enter your company's website
Your answer
Email Address *
Please indicate the email address you would like us to use to contact you. Note that email is our primary form of communication
Your answer
Are you a Maine Licensed Professional Engineer? *
Please indicate your Maine licensure status
Choose
Yes
No
If yes, please indicate your Maine P. E. Number
Please indicate your Maine licensure status
Your answer
Are you licensed in other States? *
Please indicate whether you are licensed P. E. in other States
Choose
Yes
No
If yes, please list other States
Please list other States where you are Licensed
Your answer
If you are not a P.E., do you hold E.I.T. status?
Please indicate whether you are an E.I.T.
Choose
Yes
No
Are you currently practicing Structural Engineering? *
Please indicate whether you are currently practicing Structural Engineering?
Choose
Yes
No
Are you currently a student enrolled in an ABET accredited Engineering or Technical program? *
Please indicate whether you student status
Choose
No
2 Year Program
4 Year Program
Graduate Program
If you are a Student, please indicate your School
Please indicate your school
Your answer
Membership Categories *
Please check the category of membership you are applying for
Choose
Member, Maine Licensed Structural P.E. ($60 until 2/2/18)
Associate Member, Professional ($60 until 2/2/18)
Member, Retired ($20)
Maine E.I.T. ($25)
Student (No Fee)
What information do you want to be included on SEAM's website
Areas of expertise to list on SEAM's Website
Payment Method *
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PayPal/Credit/Debit
Check
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