ISEE Membership


															

																
													

													

















































































































































































































Member Benefits
															

																

















































































































































































































































Membership Categories
															

																

























































































































































































Online Membership Application
															

																




















































































































































































































Online Membership Renewal
		

																		





























































































































































































Printable Membership Application
															
															

																
























Change Of Address
		





































































































































































ISEE Home


													


												
























2007 Membership Renewal Form








															
															

															
																It is important to refer to your Membership Dues Statement or your 2006 Membership Directory and Desk Reference, when filling out this form.  If you use this form, do not also send forms or payment by mail and/or fax.  You will receive a letter from the Membership Department confirming your payment has been processed within 7-10 days.

																

																
																	
																	
																	
																


























































															





















































																				

																					
																					
ISEE Member ID Number

																					
																				

																					
																			

																			




































																			


																		


																		

																			
Credit Card Information
																		

																		













																				

																					
																					










































































Credit Card Type 

																					
																					









																			

																			



























																			














																				





																					









































































Card Number

																				

																					
																			

																			



























																			



																			
																			

																				Name IMPRINTED on Credit Card
																				
																			
																			
																			

																			
																			



































Expiration Date










																			

																			





















																			










































Member 






































Dues Amount










																			

																			



























																			



																			
																		

																			Section Membership Dues
																		

																		

																			
																			
																			Seismic Section Add $15.00

																					
																					Drilling Section Add $15.00

																					
																					
																					Fragblast Section Add $15.00		
																			
																		

																		

																				Optional Contributions
																			

																			

																		



















																				

																					

																					



																					




																					

																						
																					
																					












SEE Education Foundation Contribution




																					
																					
																						

																						
																					


																					
																				

																				

																				



																				



																			

																			










Add $10.00

																					
																				
																				
																				Add $25.00

																					
																				
																				
																				Add $50.00

																					
																				
																				
																				Add $100.00		
																			


																		

																		
																		

																			
																				

																					For All Active Members Residing in the United States

																							As part of your ISEE Membership Benefits, you are covered by ISEE Group Accidental Death & Dismemberment Insurance. Please list below the name of your primary beneficiary (full name and relationship). 

																						

																					
																		

																		

																			Beneficiary Name
																			
																		

																		

																			Relationship
																			
																		

																		






































































Changes
																			

																			























																				
																				

																					

																					


																						














































																						

																						






















Information on my Membership Record needs to be changed.

																								
																								(Please continue to fill out the rest of this online form)		
																						


																					

																					


																						





































































																						

																						















































																							

																							
























																						


																					

																					


																						





































































																						

																						


























All of the information on my Membership Record is correct.

																								
																								
																								























Proceed to the submit button below.		
																						


																					

																				

																				
																				














































																			


																		



																				
																				
																				

																					
																					




Directory Address

																				
																					
																				

																				
																				









































































Last Name
																			

																			


























 
																			



																		

																			First Name
																			
																			
																			
																		

																		





































Student Member/Univevsity
																			

																			












																			









































































Title
																			

																			



























																			









































































Company
																			

																			



























																			









































































Address
																			

																			



























																			



																			

																				City
																				
																			
																			
																			

																			






































































State/Providence
																			

																			



























																			


																			

																			






































































Postal Code
																			

																			



























																			


																			







































































Country
																			

																			























																			









































































Business Phone
																			

																			























																			









































































Fax
																			

																			























																			





















































































E-Mail
																			

																			























																			









































































Website
																			

																			























																			









































































Home Phone
																			

																			



























																			









































































Mailing Address (Correct Your Mailing Address Below (If your mailing address is different from the address above, otherwise proceed to submit.)
																			










































































Name
																			

																			























																			









































































Company
																			

																			























																			









































































Address
																			

																			



























																			





















































































City
																			

																			



























																			





















































































State/Province
																			

																			



























																			





















































































Postal Code/Zip
																			

																			



























																			





















































































Country
																			

																			



























																			





																				
																				
																				

																					
																					Other 
Information 

																				
																					
																			



																		


																		






































































ISEE Chapter Membership
																			

																			
























																						
																					
																						






																						
																					
																						





																			









































































In which jurisdictions are you licensed or certified to blast?
																			

																			




























																						
																					
																						






																						
																					
																						





																			









































































What other related associations do you belong to?
																			

																			




























																						
																					
																						






																						
																					
																						
																							






																						
																					
																						
																							





																			





















































































Business Classification

																					Check ONLY ONE category below that best identifies the nature of your business.		



















































































																				























































Agricultural/Forestry/Logging/Avalanche Control


















































































Amusement/Recreation/Entertainment/Pyrotechnics/Special Effects


















































































Blasting/Drilling Contractor


















































































Consultant Blasting


















































































Consultant Mining


















































































Construction General


















































































Construction Bridge & Tunnel


















































































Construction Excavation & Foundations


















































































Construction Highway


















































































Construction Utility/Pipeline


















































































Construction Underwater Blasting



																					

																						Education Training (Blasting, Safety, etc)
																					

																					

																						Education University/College
																					

																					















































































Explosives Disposal


















































































Environmental Specialist


















































































Government General/Regulator


















































































Government Military


















































































Government Law Enforcement/Fire Protection/Bomb Tech


















































































Insurance & Risk Management


















































































Mining Coal


















































































Mining Metal


















































































Mining Nonmetal Minerals


















































































Mining Nonmetal Stone & Sand


















































































Manufacturing/Sales Air and Gas Compressors


















































































Manufacturing/Sales Blasting Accessories & Supply


















































































Manfacturing/Sales Computers & Software


















































































Manufacturing/Sales Explosives Products


















































































Manufacturing/Sales Drilling Equipment & Supplies


















































































Manufacturing/Sales Instruments & Related Products


















































































Manufacturing/Sales Machinery & Equipment


















































































Manufacturing/Sales Magazines/Trucks


















































































Manufacturing/Sales Ordnance and Accessories


















































































Manufacturing/Sales Pumps and Pumping Equipment


















































































Oil Extraction/Exploration


















































































Retired


















































































Service Advertising/Publishing


																					


																					















































































Service Engineering & Management


















































































Service Facilities Design & Planning


















































































Service Legal


















































































Service Employment Services


















































































Service Research/Testing


















































































Service Safety Engineering


















































































Service Shipping & Handling


















































































Student


















































































Transportation Industry


















































































Vibration/Seismology Services




																				




































































































																	
																			















Comments

																
																	







































































									
												
													
												
													
												
													
												
													
												
													
												
													
												
													
												
													
												








			





													
											

												
												
												
												
													

																
												
												
												
												
													 
				

																	
												
												
													
	 this form to the ISEE.

																	
																		
												
												
												
												
												
												
												
												
												
												
												
												
												
												
												
												

																	
																		
												
												
												 to clear all of the fields in this form.

																	
																		
												
												
												
												
												
												
												
												
												
												
												
												
												
												
												
												
												
												
												
												
												
												
												
												




												
												
												
				
																
														

										

									

										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									
										
									








										
									
										
									
										
									












							

						

							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
						
							
								
						






























						
						
						




						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						
						

							

								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								
							
								








							
								
							
								
							
								
















											

											

											
Last updated Friday, December 1, 2006.

													

													Copyright © 2006, Society of Explosives Engineers, Inc. 

													30325 Bainbridge Road, Cleveland, OH 44139

													All Rights Reserved. 

												

												membership@isee.org