ESC Membership Application
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Thank you for your interest in ESC membership!

Please follow these easy instructions to expedite your application for membership:

* indicates required fields

1. Membership Grade Selection - see descriptions below

Active Member: An active member shall be a person qualified as described in any of the following subsections:

Shall be a registered professional engineer or a scientist in any state; or

Shall have a degree from an accredited four (4) year engineering or science program and a record of active practice in the profession or in related work that indicates professional competence; or

Shall have attained the knowledge and skill approximating that required for graduation from an accredited four (4) year engineering or science program, and a record of active practice in the profession or in related work; or

Any person who is not employed directly as an engineer or scientist, but who by virtue of work, supervision, teaching, or other related activities has involvement in engineering or science;

Life Member: A life member having held continuous active membership in ESC for thirty (30) or more years shall advance to life membership without further payment of dues if the member has reached sixty (60) years of age. Members older than sixty (60) years of age shall advance to life membership when the sum of age and years of membership equals ninety (90).

Student Member: A student member shall be enrolled in a technical curriculum (engineering or science) at a Cincinnati area college.

 
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I wish to apply for admission to the grade of Active Member
Student Member
I wish to apply for advancement to the grade of Life Member
2. Name and Address (remember to inidicate your preferred mailing address)
Title: Mr. Mrs. Ms. Dr. Prof.
Other:
Business Title
Last Name*
First Name*
Middle Name
Suffix
Residential Phone*
Primary Email*
Secondary Email
Residential Street Address/PO Box
City
State
Zip or Postal Code
Country
Employer
Your Work Phone*
Your Work Fax
Your Work Street Address
Your Work City
Your Work State/Province
Your Work Country
Your Work Zip/Postal Code
Please send ESC mailings to Residential Address
Your Work Address
3A. Personal Information (mandatory)
Date of Birth*
4. Educational Information
Please specify COLLEGES/UNIVERSITIES ATTENDED, ALL DEGREE(S) RECEIVED, AND DATES(S) of all degree(s), using appropriate abbreviations when possible (i.e. BSCE, MSCE, PhD, MBA, MSEM).

No Degree Received

Degree 1: Degree 2:
School: School:
Grad Date: Grad Date:
Degree: Degree:
Degree 3: Degree 4:
School: School:
Grad Date: Grad Date:
Degree: Degree:

ALL APPLICANTS:

Comments

Payment Method (Please choose one)
Pay by Credit Card:

Pay by Check:

Mail payment to:
Engineers and Scientists of Cincinnati
PO Box 147444
Cincinnati, Oh 45214-0744
7. Sign Here

If elected, I will conform to the Constitution, Bylaws, Rules of Policy and Procedure of the Society and to the Code of Ethics.

(Agreed)*         Date*

* = information required to process this form