APPLICATION FOR ASHRAE STUDENT MEMBERSHIP
 

AMERICAN SOCIETY OF HEATING, REFRIGERATING AND AIR-CONDITIONING

ENGINEERS, INC. 1791 Tullie Circle, N.E., Atlanta, GA 30329, U.S.A.

Telephone (404) 636-8400 (Worldwide); (800) 527-4723 (U.S. and Canada Only) FAX (404) 321-5478
_____________________________________________________________________________________

(PLEASE PRINT OR TYPE ALL INFORMATION ON APPLICATION)
_____________________________________________________________________________________
DUES: Annual dues are $8.00 (must accompany your application for student membership). The dues submitted along with your student application are applicable for one year from the date of election. [Includes $6.00 for ASHRAE Journal and is not deductible from dues.]
_____________________________________________________________________________________
APPLICANT: (___)MISS (___)MS (___)MR (___)MRS
 
NAME: ______________________ ________________ ____________________________
(First) (Middle) (Family)
 
DATE OF BIRTH: _____/_____/_____
(Month/Day/Year)
MAILING ADDRESS: ________________________________________________________________
(Temporary (Street Address)
School ___________________________________ ________________
Residence) (Street Address) (Apt.)
____________________________________________________
(City)
_______________________ _______________________
(State/Province) (Zip/Postal)
_______________________ _______________________
(County - U.S. Only) (Country)
____________________________________________________
(Phone - Include Area Code)
____________________________________________________
(Facsimile - Include Area Code)
____________________________________________________
(E-mail)
PERMANENT ____________________________________________________
(Home/Parents) (Street Address)
__________________________________ ________________
(Street Address) (Apt.)
____________________________________________________
(City
_______________________ _______________________
(State/Province) (Zip/Postal)
_______________________ _______________________
(County - U.S. Only) (Country)
____________________________________________________
(Phone -Include Area Code)
_____________________________________________________________________________________
CHAPTER:
__________________________________ Chapter No.___________________________
(Chapter Name) (If Known)
_____________________________________________________________________________________
EDUCATION: Name and address of school you are now attending:
__________________________________________________________
(School Name)
__________________________________________________________
(Street Address)
__________________________________________________________
(City)
___________________________ _____________________________
(State/Province) (Zip/Postal Code)
Degree you are pursuing______________________________________
Please check one: (___) Full Time (___) Part Time
Number of credits per semester/quarter__________________________
Expected graduation date: ______/_____
Any previous degrees?
__________________________________________________________
(Degree, Date Received, College/University)
 
CERTIFICATION:
 
APPLICANT: The undersigned certifies that all statements are correct.
 
_________________________________ ______________________
(Signature of Applicant) (Date)
 
FACULTY: I hereby certify that the above applicant is registered and in regular attendance as a

student.
_________________________________ ______________________
(Signature of Faculty Member) (Date)
 

SPONSOR: I hereby certify that the foregoing information is correct, to the best of my knowledge and belief. (Society Bylaws require that a sponsor be an Associate Member or full-grade Member.)

_________________________________ ______________________
(Signature of Sponsor) (Date)
_________________________________ ______________________
(ASHRAE Membership Grade) (Membership Number)
 
To purchase one or more Handbooks, please check the appropriate box. For print editions, indicate IP (inch/pound) or SI (metric). CD contains both versions.
*(___) Please check here if you have already received a copy of the Fundamentals Handbook from a faculty member (Consignment).
 
ASHRAE Membership Dues $8.00
 
*(___) Fundamentals __CD __IP __SI $39.00 _____
*(___) Fundamentals Package (Book and CD) __IP __SI $69.00 _____
(___) Refrigeration __CD __IP __SI $39.00 _____
(___) Refrigeration Package (Book and CD) __IP __SI $69.00 _____
(___) HVAC Applications __IP __SI $39.00 _____
(___) HVAC Systems __CD __IP __SI $39.00 _____
(___) HVAC Systems Package (Book & CD) __IP __SI $69.00 _____
TOTAL: _____
 
PAYMENT: May be made by check or credit card.
Checks - must be drawn in U.S. or Canadian Funds from U.S. or Canadian banks.
Credit Card - complete all information requested below:
 
(___)VISA (___) MasterCard (___) American Express (___) Diner's
Credit Card No. __________________________________________________
Expiration Date ________________ Amount __________________________
Signature __________________________________________________
(Required for Credit Card Payment)

Revised 01/22/03