ISEE MEMBER APPLICATION

Directory Address (Official address to be used in the Annual Membership Directory)

(Please Print)

First Name___________________________MI_______Last Name_______________________________Job Title_____________

Company/Organization________________________________________________E-mail_______________________________
Bus. Phone__________________________Bus. Fax_______________________________Cell Phone_______________________
Street____________________________________City______________________________State/Province__________________
Postal Code/Zip____________________Country_____________________  Please add my e-mail to the technical listserve.

Mailing Address (I want all mail to be sent to a different address than above)
Street_________________________________City______________________________State/Province_____________________
Postal Code/Zip_____________________Country_________________________Home Phone____________________________

Members: Individuals whose work involves the direct application of scientific principles and techniques in the use, handling, manufacture, transportation
and storage of explosives. Associate Members: Those who are interested in explosives engineering, but are not qualified to be a Member.
Student Members: Full-time students enrolled in science or engineering. Copy of student ID is required. Corporate Members: Corporations whose
purpose and activities relate to the explosives industry. Life Members: Call ISEE for more information.

List Blaster’s License Held____________________________List Membership in ISEE Chapter(s)__________________________

 Enclosed is a copy of my blaster’s license  Enclosed is a copy of my student I.D. (Student Members)
Does the applicant have actual hands-on blasting experience?_________________
I hereby apply for: Member $80 U.S. Associate Member $80 U.S. Corporate Member $395 U.S. Full-time Student $20 U.S.
I offer the attached information in support of my application for membership. If accepted for membership, I agree to comply with the con-
stitution and code of ethics of the ISEE. My dues payment is enclosed.
Signature of Applicant_______________________________Date of Birth_____________
* International payments should be made via international money order or bank draft drawn on a U.S. bank. For Federal income tax
purposes, your membership dues may be deductible as a business expense but not as a charitable contribution.
Method of Payment VISA MASTERCARD AMEX Card#___________________________________________________

Signature_______________________________________________________Expiration Date____________________________
 My check is enclosed.

Endorsement Information
All applicants except full-time students over 18 years of age, must be at least 21 years old and be endorsed by a Chapter official, ISEE
member, or appropriate government official who knows the applicant personally. If you cannot locate a sponsor, call the ISEE office
for more information. Membership in another engineering society that has equally high standards of membership may be used in place
of the endorsement. All applications for membership, in order to approved, shall be accompanied by a summary of the applicant’s
employment experience and education background along with the first year’s annual dues.
Name of Endorser__________________________Company_____________________________Member #__________________
How long have you known the applicant?____________Has the applicant been employed under your supervision?_________
I hereby endorse the above applicant for membership in the ISEE Signature of Endorser_______________________

Business Classifications (circle the one that best describes your company)
Agriculture/Forestry/Logging/
Avalanche Control
Amusement/Recreation/Entertain/
Pyrotechnics/Special Effects
Blasting/Drilling Contractor
Construction Bridge & Tunnel
Construction Demolition
Constr Excavation & Foundations
Construction General
Construction Highway
Construction Underwater Blasting
Construction Utility/Pipeline
Consultant Blasting
Consultant Mining
Education-Training
(Blasting, Safety, etc.)
Education-Training
(University/College)
Environmental Specialist
Explosives Disposal
Gov’t General/Regulator
Gov’t Military
Gov’t Law Enforcement/
Fire Protection/Bomb Tech
Insurance & Risk Management
Mining Coal
Mining Metal
Mining Nonmetal Minerals
Mining Nonmetal Stone & Sand
Mfg/Sales Air & Gas Compressors
Mfg/Sales Blasting Accessories &
Supply
Mfg/Sales Drilling Equipment &
Accessories
Mfg/Sales Explosives Products
Mfg/Sales Instr & Related Products
Mfg/Sales Machinery & Equip.
Mfg/Sales Magazines/Trucks
Mfg/Sales Ordnance & Accessories
Mfg/Sales Pumps and Pumping
Equipment
Mfg/Sales Software - Blast Design/
Vibration/Inventory
Oil Extraction/Exploration
Retired
Service Advertising/Publishing
Service Employment
Service Engineering & Mgmt
Service Facilities Design &
Planning
Service Legal
Service Research/Testing
Service Safety Engineering
Service Shipping & Hauling
Student
Transportation Industry
Vibration/Seismology Services
07/08

Int’l Society of Explosives Engineers • 30325 Bainbridge Road • Cleveland,

Ohio • 44139 • (440) 349-4400• Fax: (440) 349-3788 • www.isee.org