Indiana Structural Engineers Association

Member Application

* First

* Last

Title

* Company

* Business Address

* City

* State

* Zip

* Phone

* Email

* Are you a licensed P.E. in Indiana

Yes
No

If applicable, please input your Indiana P.E. registration number

Are you a licensed S.E.

Yes
No

If applicable, please input the State and S.E. registration number

If not a P.E. or S.E., do you currently hold E.I.T. status

Yes
No

In which state do you hold E.I.T status?

* Are you currently a student enrolled in an ABET accredited engineering or technical program?

Yes
No

School Name

Type of program

2 year
4 year
Gradute

* Category of Membership

Member
Associate Member
Student Member
Affiliate Member

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