EmailMe Form - CSSE Membership Application

Date *

MM / DD / YYYY

Last Name *

Given Names *

Mailing Address *

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country / Region

Telephone *

### - ### - ####

Email *

Education

Post-secondary Education - University/College(s)

Degree(s)/Diploma(s)/Certificate(s) etc.

Memberships in other societies or professional association(s)

Years of work in a Canadian and/or other engineering environment

CSSE Member who recommended The CSSE to me

(if applicable)

PAYMENT

1. Please read PAYMENT INFORMATION, click on a box to choose Payment Method (credit card or cheque) and Total your amount of payment.

2. Enter the IMAGE VERIFICATION text and click on the SUBMIT button.

PAYMENT INFORMATION

Applicants for membership are required to pay the membership fee upon acceptance into the Society. If an applicant applies and is accepted into the Society after 31 October, the membership fee will cover the balance of that year, as well as the following year, or part thereof. New members will then pay the membership fee for subsequent years. CSSE members are invited to make annual charitable donations to CSSE, which donations are acknowledged with an income tax receipt. Donations made by cheque can be any amount, however donations made by credit card must be made on the Members Page in the following amounts (or multiples of the amount): $25 $100 $200 Example: 2 X $200 = $400.

Members also are encouraged to consider making a bequest to CSSE (thus reducing the amount of estate taxes).

Payment Method *

To pay by credit card, click on the link provided on the confirmation page which appears after you SUBMIT your application.

To pay by cheque, please make payable to The Canadian Society of Senior Engineers and mail to: The Canadian Society of Senior Engineers, 464 Briar Avenue, Ottawa, Ontario, K1H 5H6. Telephone: (613) 890-9363

(please choose one)

Total amount of payment *

(membership fee and donation if applicable)