GENERAL MEMBERSHIP APPLICATION

New membership Renewing membership If renewing, NACE Member #:

PERSONAL & COMPANY INFORMATION
Where do you want your information mailed? Company Home
First Name M.I. Last Name
Company
Business Address
City State/Province
Zip/Postal Code Country
E-mail
Home Address
City State/Province
Zip/Postal Code Country
Business Phone Business Fax
Home Phone Mobile Phone
Birthdate (MM/DD/YY)
PROFESSIONAL INTERESTS
A. Gender Male Female
B. Education Level Associate’s Degree Bachelor’s Degree Master’s Degree Doctoral Degree Post-Doctoral Work
Other Education Level
C. Professional Engineer’s License Yes No
D. How did you first hear about NACE? Advertisement Education Course Internet NACE Conference/Event NACE Publication
NACE Catalog Other
E. Preferred Language English Spanish Chinese
F. My job function can be best described as (select all that apply)
Architect/Designer Executive/Senior Management Plant/Facility Manager Specifier
Attorney/General Council Health & Safety/Compliance Manager Project Manager/Supervisor Student
Chemist Human Resources Professor/Instructor Systems Manager/Operator
Coatings Applicator Inspector Purchasing/Buyer Technician/Technologist
Coatings Inspector Integrity Manager QA/QC Tester
Consultant Maintenance Retired Trainer
Contractor Media Buyer/Press Liaison/Acct Sales/Marketing Other/Job Function Not Listed
Engineer Executive Scientist/Researcher
G. Products I use or sell (select all that apply)
Abrasives Insulation
Adhesives Linings
Application Equipment Materials—Ferrous
Cathodic/Anodic Protection Materials—Nonferrous
Chemical Inhibitors Mechnical Equipment/Machinery
Coatings Monitoring Equipment
Concrete Safety Equipment
Data Recording & Management Equipment/Software Surface Preparation Equipment
Inspection Equipment Testing Equipment
H. My company serves these industry segments (select all that apply)
INFRASTRUCTURE UTILITIES TRANSPORTATION PRODUCTION & MANUFACTURING GOVERNMENT
Airports Coal Aerospace/Aircraft Agricultural Equipment DoD—Military
Gas & Liquid Pipelines Electric Automotive/Motor Vehicle Chemical/Petrochemical Nuclear Waste
Hazardous Material Gas Distribution Hazardous Material Electronics Storage
Storage Nuclear Transport Food Processing Other/Industry
Highways/Bridges Solar Marine/Ships Home Appliances Segment Not Listed
Railroads Telecommunications Railroad Cars Medical
Waterways & Ports Water/Wastewater Other Transportation Mining
Other Infrastructure Wind Oil/Gas Exploration &
Production
Pulp & Paper
Refinery/Gas Processing
FM_MEM_03.v02
I. My company is a(n)
Academia/R & D Association Manufacturer/Supplier Service Provider/Contractor
Asset Owner/Operator Government/Regulatory Media/PR/Advertising Agency No Company Affiliation
Agency
J. Company Function (select all that apply)
Aboveground Storage Contractor, Insulation Maintenance/Rehabilitation Ship Building
Architectural/Design Contractor, Roofing Materials Selection & Design Surface Preparation/Blasting
Cathodic/Anodic Protection Contractor, Sandblast/ Measuring, Analyzing & Testing Services
Chemical Processing Waterblast/Surface Prep Controlling Instrumentation Training
Coatings Contractor, Spray Bed Liner Metal Fabrication Underground Storage
Concrete Contractor, Structural Steel, Offshore Water, Domestic
Construction Metal Tank and/or Pipeline Onshore Water, Industrial
Contractor, Commercial Engineering Original Equipment Manufacturer Wastewater, Domestic
Coatings Fleet Operator Power/Energy Distribution Wastewater, Industrial
Contractor, Concrete Specialty Inspection Services Power/Energy Generation Wind
and/or Parking Structure Insulation Power/Energy Transmission Other/Company Function
Contractor, Flooring Insurance Rail Cars/Tank Trucks Not Listed
Contractor, General Legal Services Refining/Gas Processing
Contractor, Industrial Plant or Linings Laboratory/Research
Military Facilities Maintenance
K. My role in continuing education/professional development/training decisions (select all that apply)
Recommend Specify Authorize Buy
L. My role in product decisions (select all that apply)
Recommend Specify Authorize Buy
OPTIONS OF MEMBERSHIP & SERVICES
AMOUNT TOTAL
1 YEAR 2 YEARS
Individual Membership
$140 membership dues include $12 (not deductible) for a Materials Performance subscription, and $1 for dual membership in the NACE $140 $270
International Institute. To opt out of the NACE International Institute membership, visit www.nace.org/optout; $1 will go back to NACE International.

Subscription to CORROSION journal $85 $160

$85 only includes access to the online journal • $105 includes both the printed and online journal.
Librarians representing an institution or library (academic, corporate, private, public, etc.) must pay the institution rate. $105 $200

Membership Certificate $25

NACE Foundation Donation $25 $50 $75 $100 Other $
NACE Foundation Donation of Canada $25 $50 $75 $100 Other $
Donations to the NACE Foundation support our education programs and scholarships. We continue to be dedicated to advancing corrosion
education and inspiring the future generation of corrosion professionals who will protect the world’s infrastructure from the effects of corrosion.
Donations in the U.S. are tax-deductible to the full extent of the law. Contributions outside the U.S. may not be tax-deductible; therefore, review your
local tax laws. For more information, please contact the NACE Foundation at foundation@nace.org or visit www.nace-foundation.org.

Donation in memory of:

Add dues and options to calculate the total amount to be paid. Amount Paid
PAYMENT OPTIONS
Payments can be made by check, money order, or credit card in U.S. funds made payable to NACE.
For faster processing, please visit our Web site at www.nace.org.
Check/money order enclosed: U.S. $ Check number:
Credit card payment: MasterCard VISA American Express Discover
Account number: Expiration Date: MM: YY:
Name as it appears on card:
Signature:
For more information, contact NACE FirstService at firstservice@nace.org.
By submitting this application to join or renew your membership with NACE International, you agree to abide by the
NACE International Code of Ethics for members and the NACE International Policies and Procedures as established by the NACE Board of Directors.
The NACE Code of Ethics and Policies and Procedures may both be found at nace.org/officers

Mail completed application with payment to: NACE International

15835 Park Ten Place
Houston, TX 77084-4906
USA