NCAEP Membership Application

Sep 11, 2008
Raleigh Dinner Meeting: Evolution of Green Communities
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Please provide the following information:

Regular Member	Must be a member of the NAEP; dues are $25 per year in addition to the NAEP dues. NAEP member number (5-digits):
State Member	Dues are $25 per year for Jan. thru Dec. (pro-rated based on the calendar year)
Government Member	Dues are $12.50 per year for Jan. thru Dec.
Student Member	Must be a full-time student; dues are $10 per year

Name

Home Address (1)

Home Address (2)

Home City/State/Zip

Affiliation/Business

Position

Business Address (1)

Business Address (2)

Business City/State/Zip

Preference for Mailings: Home Business

Business Telephone No.

Home Telephone No.

Fax No.

E-mail Address

Education/Degrees

Practice Setting (check most applicable)

Academia
Government
Private Sector (Consulting, Contracting, Industry)
Other (please specify)

Areas of Interest (please check all that apply)

Water Quality
Wetlands
Ecology
Natural Resources Management
Protected Species
NEPA/SEPA
Other:

Air Quality
Hazardous Materials Management
Environmental Justice
Secondary/Cumulative Impact Assessments
Historic/Archeological Resources

Student Members
Please provide the following information:

College/University

Program/Major

Graduation Date

Where did you hear about NCAEP?

Source: