Society for Mining, Metallurgy, and Exploration, Inc.


12999 E. Adam Aircraft Circle  Englewood, CO 80112
Phone: (303) 948-4204  Fax: (303) 948-4265  e-mail:
emas@smenet.org
Last Name:

Approved Please Do NOT Type in This Space

 FOR OFFICE USE ONLY
Student Dues - $32 per year
Contact Information:
Prefix: Mr. Mrs. Ms. Dr. Male Female

Name: Last: MEZA PEÑALOZA First: JAMPIER NICOL MI:

School Name: UNIVERSIDAD NACIONAL DE MOQUEGUA Major: INGENIERIA DE MINAS
Email Address: Birth Date:
School Mailing Address
Street or PO Box: Prolongacion Calle Ancash S/N
Mariscal
City: Moquegua State: Nieto Zip/PC +51 Country Perú
Phone: Fax:
Home Mailing Address:

Street or PO Box:
City: Moquegua State: Zip/PC +51 Country Perú
Phone: Fax:
Preferred Mailing Address: Home School

Student Member Qualifications

A person eligible for election into the class of Student Member must be a full-time college undergraduate or graduate student in
good standing. A professional Member who subsequently returns to school for an additional degree cannot become a Student
Member. All Student Members must be nominated by an existing Member.

Signature
If elected, I agree to abide by the bylaws and rules of the Society for Mining, Metallurgy, and Exploration, Inc. as the same are now in effect and as
they may hereafter be modified while I am a member. I understand that under certain laws and regulations, SME must have my permission in order
to communicate with me via fax or email. I hereby give SME Foundation, SME Local Sections and SME business associates permission to send
me information and advertisements. If SME does NOT have your permission to communicate with you via fax or email, you many not have access
to some of your electronic member benefits.

Signature: (type or sign your name) Date:

Endorsement
Student Member application must be endorsed by an SME Professional or Registered Member.

Name: Member #:

If you currently do not have an endorser, check this box and we will assign one for you.

SME Membership was recommended to me by:

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Education
Please list school, degree, major, and the date of graduation. Student Members must be full-time students at a school approved by SME
Name of School: UNIVERSIDAD NACIONAL DE MOQUEGUA
Expected Degree: Major: INGENIERIA DE MINAS
Expected Date of Graduation:

Divisional/Technical Interest
Please indicate, in order of preference (1, 2, 3), a minimum of one and no more than three, technical interest categories.
Divisions: Coal & Energy (F) Technical Bulk Material Handling (M)
Environmental (E) Interest Education (J)
Industrial Minerals (H) Committees:
International Marine Minerals (I)
Mining & Exploration (Metallics) (A)
Mineral & Metallurgical Processing (B)
Underground Construction Association (U)

Industry Sector
Coal Mining (1B) Geology/Exploration (8) Metallurgy (9)
Coal Processing (6) Government (2) Metals Mining (1A)
Economics (4) Industrial Minerals Mining (1C) Metals Processing (10)
Education (3) Industrial Minerals Processing (1D) Underground Construction/Tunneling (11)
Environmental (7) Manufacturing (5)

Payment
DUES ARE PAYABLE ON A CALENDAR YEAR BASIS. PAYMENT MUST ACCOMPANY APPLICATION.
Credit Card Check Cash Wire Transfer (contact SME at emas@smenet.org for instructions)

Credit Card Info: Visa MasterCard American Express Discover

Card Number: Expiry: Sec. Code
Signature (type or sign your name):

Dues: $ 32
Total $ 32 Please calculate your total here (US Dollars)

UPON COMPLETION OF APPLICATION SEND TO:

 Email: emas@smenet.org or
 Fax: (303) 948-4265 or
 Mail: Society for Mining, Metallurgy, & Exploration
12999 E. Adam Aircraft Circle
Englewood, CO 80112
 Questions? Please contact Billie Emas at (303) 948-4204 or toll free (800) 763-3132 or
emas@smenet.org

THANK YOU!