ISEE Corporate Membership Application

Membership

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ISEE Online Corporate Membership Application

Please fill out this form to apply for membership to the International Society of Explosives Engineers (Bolded Fields are required - application will not be processed if they are incomplete).

Information for Primary Corporate Representative
First Name
Middle Initial
Last Name
Title
Company/Organization
Business Phone
Business Fax
Home Phone
Cell Phone
Address 1- (Primary Representative) (Official address to be PRINTED in the Annual Membership Directory under Corporate Section)
Street
City
State/Province
Zip/Postal Code
Country
Email
Address 2 - (Primary Representative) (I want my mail to be sent to a different address than above)
Street
City
State/Province
Zip/Postal Code
Country
Date of Birth
List Blaster's License Held (state/province)
List Membership in ISEE Chapter(s)
ISEE Section Membership (Add $15.00 for each Section)
Seismic Section Drilling Section Fragblast Section

Information for Second Corporate Representative
First Name
Middle Initial
Last Name
Title
Company/Organization
Business Phone
Business Fax
Home Phone
Cell Phone
Address 1- (Second Representative) (Official address to be PRINTED in the Annual Membership Directory under State/Country Section)
Street
City
State/Province
Zip/Postal Code
Country
Email
Address 2 - (Second Representative) (I want my mail to be sent to a different address than above)
Street
City
State/Province
Zip/Postal Code
Country
Date of Birth
List Blaster's License Held (state/province)
List Membership in ISEE Chapter(s)
ISEE Section Membership (Add $15.00 for each Section)
Seismic Section Drilling Section Fragblast Section

Information for Third Corporate Representative
First Name
Middle Initial
Last Name
Title
Company/Organization
Business Phone
Business Fax
Home Phone
Cell Phone
Address 1- (Third Representative) (Official address to be PRINTED in the Annual Membership Directory under State/Country Section)
Street
City
State/Province
Zip/Postal Code
Country
Email
Address 2 - (Third Representative) (I want my mail to be sent to a different address than above)
Street
City
State/Province
Zip/Postal Code
Country
Date of Birth
List Blaster's License Held (state/province)
List Membership in ISEE Chapter(s)
ISEE Section Membership (Add $15.00 for each Section)
Seismic Section Drilling Section Fragblast Section

I hereby apply for Corporate Membership	$395.00
SEE Education Foundation (optional contribution)	$50.00 $75.00 $100.00 $150.00
Acceptance of Application I Accept I Decline	I offer the attached information in support of my application for membership. If accepted for membership, I agree to comply with the Constitution, and Code of Ethics of the Society. My dues payment is enclosed. *International payments should be made via international money order, US bank draft, or by credit card. For US federal income tax purposes, your non-refundable membership dues may be deductible as a business expense, but not as a charitable contribution.
Please indicate the method you will be sending your support information	Fax/Mail Copy of Blaster's License Email Attachment Fax/Mail Copy of Student I.D.
Payment
Credit Card Type
Credit Card Number
Name IMPRINTED on Card
Expiration Date

Business Classification Select ONLY ONE category below that best identifies the nature of your business.

this form to the ISEE.

to clear all the fields in the form.

ISEE | 30325 Bainbridge Road | Cleveland, OH 44139 USA| Tel: 440-349-4400 | Fax: 440-349-3788