ISEE Online Membership Application

Membership

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ISEE Online Membership Application

Please fill out this form to apply for membership to the International Society of Explosives Engineers (Bolded Fields are required - application will not be processed if they are incomplete).

First Name
Middle Initial
Last Name
Title
Company/Organization
Business Phone
Business Fax
Home Phone
Cell Phone
Address 1 (Official address to be PRINTED in the Annual Membership Directory)
Street
City
State/Province
Zip/Postal Code
Country
Email
Address 2 (I want my mail to be sent to a different address than above)
Street
City
State/Province
Zip/Postal Code
Country

Date of Birth
List Blaster's License Held (state/province)
List Membership in ISEE Chapter(s)

Membership Type
ISEE Section Membership	Seismic Section - Add $15.00
	Drilling Section - Add $15.00
	Fragblast Section - Add $15.00
SEE Education Foundation (optional contribution)	$10.00 $25.00 $50.00 $100.00
Acceptance of Application I Accept I Decline	I offer the attached information in support of my application for membership. If accepted for membership, I agree to comply with the Constitution, and Code of Ethics of the Society. My dues payment is enclosed. *International payments should be made via international money order, US bank draft, or by credit card. For US federal income tax purposes, your non-refundable membership dues may be deductible as a business expense, but not as a charitable contribution.
Please indicate the method you will be sending your support information	Fax/Mail Copy of Blaster's License Email Attachment Fax/Mail Copy of Student I.D.
Payment
Credit Card Type
Credit Card Number
Name IMPRINTED on Card
Expiration Date
Endorsement Information - ALL applicants, except full-time students over 18 years of age, must be at least 21 years old and be endorsed by an ISEE Chapter official, ISEE member, or appropriate government official who knows the applicant personally. If you cannot locate a sponsor, call the ISEE office for more information. Membership in another engineering society that has equally high standards of membership may be used in place of the endorsement.
Name of Endorser
Company
Phone Number
ISEE Member Number
How long have you known the applicant?
Has the applicant been employed under your supervision?
Does the applicant have actual hands-on blasting experience?
Business Classification Select ONLY ONE category below that best identifies the nature of your business.

this form to the ISEE.

to clear all the fields in the form.

ISEE | 30325 Bainbridge Road | Cleveland, OH 44139 USA| Tel: 440-349-4400 | Fax: 440-349-3788