DIRECTED ENERGY PROFESSIONAL SOCIETY Membership Application Thank you for supporting the important work of the Directed Energy Professional Society. This form collects the information necessary for DEPS to process your membership. Asterisks note the fields required by DEPS to process your membership. Personal Information * Full Name:    Title: * Organization:   * Address: * City: * State:    Country: * Zip code:   * Phone: * E-mail: * E-mail (confirm)   To reduce errors, we ask that you enter your email a second time.   * Membership category: Annual dues       Standard membership $75       Full-time government employee $50       Full-time student $10       Full-time educator $10   * Are you renewing your membership?    Yes    No      If yes, what is your member number?      * Payment:       Submit credit card payment at this time using our secure server       Send payment to DEPS     Optional personal information (used for Society statistical records only): Highest degree      Institution: Degree discipline:      Year: Birth Year:      Interest area: Referred by:       Information in this form will be used for Society membership records and statistics. We may at times publish membership information. If you do not want your name or address released, please check here:   Do not release my e-mail or mailing address Do not release my name, organization, e-mail, or mailing address Once you have completed the fields on this form, press the Submit button to process this information and proceed with on-line payment if requested. The Reset button will clear the entire form.         Copyright 2010 Directed Energy Professional Society   DHTML/JavaScript Menus by OpenCube

Last updated: 24 June 2010