Membership Application s1

460 Smith St, Ste K Middletown, CT 06457 Phone: (860) 635-5522/Fax: (866) 668-9858 Email: [email protected] www.ctengineers.org MEMBERSHIP APPLICATION Name of Firm

Business Address

Mailing Address (if different from above)

City State Zip

Is this office a branch office or subsidiary of a multi-location firm? :Yes – main office is located in ٱ  No 

Partnership ٱ Ownership:  Sole Proprietor   Privately-Owned Corporation  Publicly-Held Corporation Principals: include P.E. after name if registered in Connecticut. First principal listed will be our primary contact.

Name: email: 1. 2. 3. 4.

Staff distribution by activity in Connecticut office(s): Principals (P.E.s) Principals (not P.E.s) Design Engineers (P.E.s) Design Engineers (not P.E.s) Drafters and Technicians Inspectors and Field Personnel Land Surveyors Other Total

Type of Engineering services your firm provides: Civil Structural Hazardous Waste Remediation Civil Transportation Electrical Civil/Roadway Mechanical Civil/Site Surveying Environmental HVAC General or Municipal Architecture Geotechnical/Soils Other:

7/1/2012 460 Smith St, Ste K Middletown, CT 06457 Phone: (860) 635-5522/Fax: (866) 668-9858 Email: [email protected] www.ctengineers.org

Membership in ACEC/CT and ACEC is limited to firms providing consulting engineering services. At least one of the principals of the firm must be Professional Engineer registered with the State of Connecticut. When your application is approved, you will be a member of both the American Council of Engineering Companies and the American Council of Engineering Companies of Connecticut. 2012-2013 Dues Schedule New Member Incentive Program: New members pay only 1/3 dues the first year, 2/3 dues the second year and full dues thereafter.

Total ACEC ACEC/CT Total First Year Staff Dues Dues Dues Dues 1 $421 $363 $784 $265 5 $813 $911 $1,724 $585 10 $1,208 $1,353 $2,561 $870 20 $1,796 $2,011 $3,807 $1,293 50 $3,032 $3,394 $6,426 $2,183 100 $4,505 $5,044 $9,549 $3,244 Dues are approximate. Actual dues will be computed using the total number of staff. First year dues are pro-rated based on a July 1 – June 30 fiscal year. If you are already a member of ACEC National through other dues, only pay ACEC/CT dues for Membership to ACEC/CT.

Membership dues entitle you to:

→ The Last Word email newsletter → ACEC/CT email newsletter → ACEC Insurance Programs → Connecticut QBS Council → Your voice in Washington, D.C. → Your voice in Hartford → Annual Meetings and special seminars → State meetings and seminars → Workshops, Publications and Contracts → Coalitions for Structural, Mechanical/ → National Advertising Electrical, and Geotechnical Engineers → Referral services and web site directory

Return with dues to: 460 Smith St, Ste K, Middletown, CT 06457 Phone: (860) 635-5522 Fax: (866) 668-9858 Email: [email protected]

______Signature Date

If you have any questions about your application or membership, please feel free to call our office at (860) 635-5522 or email [email protected].

7/1/2012