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. Several methods of payment are offered, including using our secure server to pay on-line at this time.

Asterisks note the fields required by DEPS to process your membership.

Full Name: *
Title:
Organization: *
 
Mailing Address: *
City: *
State: *
Zip code: *
 
Phone: *
Fax:
E-mail: *
 
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
      Submit credit card information to DEPS by phone
      Send check 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.

     

 
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Last updated: 16 January 2003