N A C E I N T E R N A T I O N A LGeneral Membership Application

Professional InterestsA. Gender Male Female

C. Professional Engineer’s License Yes No

B. Education Level Associate’s Degree Bachelor’s Degree Master’s Degree Doctoral Degree Post-Doctoral Work Other Education Level

D. How did you first hear about NACE? Advertisement Education Course Internet NACE Catalog NACE Publication NACE Conference or Event Other

E. Preferred Language English Spanish Chinese

H. My company serves these industry segments (select all that apply)INFRASTRUCTURE

Airports Gas and Liquid Pipelines Hazardous Material Storage Highways/Bridges Railroads Waterways and Ports Other Infrastructure

UTILITIES

Coal Electric Gas Distribution Nuclear Solar Telecommunications Water/Wastewater Wind

TRANSPORTATION

Aerospace/Aircraft Automotive/Motor Vehicle Hazardous Material Transport Marine/Ships Railroad Cars Other Transportation

PRODUCTION & MANUFACTURING

Agricultural Equipment Chemical—Petrochemical Electronics Food Processing Home Appliances Medical Mining Oil and Gas Exploration & Production Pulp & Paper Refinery/Gas Processing

GOVERNMENT

DOD—Military Nuclear Waste Storage

Other/Industry Segment Not Listed

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Personal and Company InformationWhere do you want your information mailed? Company Home

G. Products I use or sell (select all that apply) Abrasives Adhesives Application Equipment

Cathodic/Anodic Protection Chemical Inhibitors Coatings

Concrete Data Recording and Management Equipment/Software Inspection Equipment

Insulation Linings Materials—Ferrous

Materials—Non-Ferrous Mechanical Equipment/Machinery Monitoring Equipment

Safety Equipment Surface Preparation Equipment Testing Equipment

F. My job function can be best described as (select all that apply) Architect/Designer Attorney/General Council Chemist Coatings Applicator Coatings Inspector

Consultant Contractor Engineer Executive/Senior Management Health & Safety/Compliance Manager

Human Resources Inspector Integrity Manager Maintenance Project Manager/Supervisor

Media Buyer/Press Liaison/Account Executive Plant/Facility Manager Professor/Instructor Purchasing/Buyer QA/QC

Retired Sales/Marketing Scientist/Researcher Specifier Student

Systems Manager/Operator Technician/Technologist Tester Trainer Other/Job Function Not Listed

First Name M.I. Last Name

Company

Business Address

City State/Province

Zip/Postal Code Country

Business Phone Business Fax

Email

Home Address

City State/Province

Zip/Postal Code Country

Home Phone Mobile Phone Birthdate (MM/DD/YY) / /

NACE MEMBER #

If renewing, would you like a new membership card? Y N□ New □ Renewal

Mail completed application with payment to:NACE International1440 South Creek Dr.Houston, TX 77084-4906USA

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Options of Membership and ServiceAMOUNT TOTAL

1 YEAR 2 YEARS

Individual Membership$130 membership dues include $12 (not deductible) for a Materials Performance subscription, and $1 for dual membership in the NACE International Institute. To opt out of the NACE International Institute membership, visit www.nace.org/optout; $1 will go back to NACE International.

$130 $250

Individual Membership with CORROSION journal $215 only includes access to the online journal • $235 includes both the printed and online journal. Librarians representing an institution or library (academic, corporate, private, public, etc.) must pay the institution rate.

$215$235

$420$450

Membership Certificate $20

NACE Foundation Donation □ $25 □ $50 □ $75 □ $100 □ Other

NACE Foundation of Canada Donation □ $25 □ $50 □ $75 □ $100 □ OtherDonations 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 honor/memory of:

$______

$______

Add dues and options to calculate total amount to be paid. Amount paid

Payment OptionsPayments can be made by check, money order, or credit card in U.S. funds made payable to NACE.

For faster processing, consider paying by credit card and faxing this form to NACE at +1 281-228-6329.

□ Check/money enclosed: U.S. $ Check number:

Credit card payment: □ MasterCard □ VISA □ American Express □ Discover

FOR MORE INFORMATION, CONTACT NACE FIRSTSERVICE AT 1 800-797-NACE (6223) OR +1 281-228-6223 (WORLDWIDE).

Above Ground Storage Architectural/Design Cathodic/Anodic Protection Chemical Processing Coatings Concrete Construction Contractor, Commercial Coatings Contractor, Concrete Specialty and/or

Parking Structure

J. Company function (select all that apply) Contractor, Flooring Contractor, General Contractor, Industrial Plant or Military

Facilities Maintenance Contractor, Insulation Contractor, Roofing Contractor, Sandblast/Waterblast/

Surface Prep Contractor, Spray Bed Liner Contractor, Structural Steel, Metal

Tank and/or Pipeline

Engineering Fleet Operator Inspection Services Insulation Insurance Legal Services Linings Maintenance/Rehabilitation Materials Selection & Design Measuring, Analyzing & Controlling

Instrumentation

Metal Fabrication Offshore Onshore Original Equipment Manufacturer Power/Energy Distribution Power/Energy Generation Power/Energy Transmission Rail Cars/Tank Trucks Refining/Gas Processing Laboratory/Research Ship Building

Surface Preparation/Blasting Testing Services Training Underground Storage Water Domestic Water Industrial Wastewater Domestic Wastewater Industrial Wind Other/Company Function Not Listed

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

Account Number Expiration Date MM YY

Name as it appears on card

Signature

I. My company is a(n) Academia/R&D Asset Owner/Operator

Association Government/Regulatory Agency

Manufacturer/Supplier Media/PR/Advertising Agency

Service Provider/Contractor No Company Affiliation