Student Membership Application

First

Middle

Last

What is your primary address?

Home

Business

Home Mailing Address

Country

Your Mailing Address at University

Email Address

Phone Number

Personal Email Address

Gender

Date of Birth

Referred By:

Name of University

Degree Information (Degree, Major)

Expected Graduation Date

Payment Type

Check or Wire Transfer

Visa

Mastercard

American Express

Credit Card Number

Expiration Date

Name on Card

CVV

Would you like to enroll in auto renewal?

Yes

Application Confirmation

I certify that the statements made in this application are correct. I pledge to abide by the Bylaws of SNAME and SNAME's Code of Ethics.