AudioEngineering Society MEMBERSHIP APPLICATION FORM All applicants complete this page in English: Please print in CAPITALS. 1 Personal Information
——————————————————————————————————————————————————————————————————— Family Name
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——————————————————————————————————————————————————————————————————— Email I desire I ADMISSION AS I MEMBER Nature of Business: I I ADVANCEMENT IN GRADE TO ASSOCIATE I Commercial Recording Studio I I REINSTATEMENT AS STUDENT I Project Recording Studio I Live Sound ————————————————————————————————————————————— I Address 1 Broadcast Station/Studio I Sound Reinforcement ————————————————————————————————————————————— I Mastering Address 2 I Internet Audio I Duplication/Replication ————————————————————————————————————————————— City State/county/province I Manufacturer: Audio Equipment I Manufacturer: Video Equipment ————————————————————————————————————————————— I Record Label Zip/post code Country I Education/Government I ————————————————————————————————————————————— Consultant Audio Engineer Phone Fax I Postproduction Facility I Dealer/Distributor/Rep. Firm ————————————————————————————————————————————— I Date of birth (year/month/day) Birthplace Film/Video Production House I Sound Contractor/Installation ————————————————————————————————————————————— I Res. & Dev. Organization Nationality I A/V Computer Soft/Hardware 2 I Venue/Auditorium Professional Information I Studying at University/College I Other ————————————————————————————————————————————— —————————————— Company/Institute or college Job Description: ————————————————————————————————————————————— Address 1 I Owner/Director I Studio/Corporate Manager ————————————————————————————————————————————— I Independent Engineer Address 2 I Engineer ————————————————————————————————————————————— I Technician City State/county/province I Production Management I ————————————————————————————————————————————— Financial Management/Buyer Zip/post code Country I Sales/Marketing I Designer ————————————————————————————————————————————— Phone Fax I Producer I Student Members Musician Year of graduation I Editor I Mixing Engineer ————————————————————————————————————————————— Faculty advisor I Educator/Student I A/V Computer Designer ————————————————————————————————————————————— I Sound Designer Email or phone number I Student I 3 Payment Other —————————————— I Online Journal only Member/Associate $125 Student $50 I Interest in AES Activities: Amount: $ ——————— Online and printed Member/Associate $200 Student $125 I Journal I Conferences I Check/Money Order I American Express I Visa I MasterCard/Eurocard I Publications I Standards I Conventions I Technical Committees ——————————————————————————————————————————— Credit Card # Expiration Date
——————————————————————————————————————————— Please return form to: Cardholder Name Audio Engineering Society, Inc. ——————————————————————————————————————————— 551 Fifth Ave., Suite 1225 Signature (all applicants) Date New York, NY 10176, USA Please send my AES mail to address I Home or I Office . Join online at http://www.aes.org ADDITIONAL INFORMATION REQUIRED FOR FULL MEMBERSHIP B. Curriculum Vitae 4 Education: (use a separate sheet, if necessary)
Institution: ——————————————————————————————————————— Place: ———————————————————
Major or Subject: ————————————————————————————————————— Attended from: —————— to: ———————
Degree awarded: ————————————————————————————————————— Number of years credit if no degree: ———————
Institution: ——————————————————————————————————————— Place: ———————————————————
Major or Subject: ————————————————————————————————————— Attended from: —————— to: ———————
Degree awarded: ————————————————————————————————————— Number of years credit if no degree: ———————
Seminars, short courses related to audio: (Give approx. hours of study involved)
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——————————————————————————————————————————————————————————————————— 5 Other Accomplishments: (list any papers, patents, etc., with appropriate dates)
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Member of other societies: ——————————————————————————————————————————————————————
Linguistic Abilities: ————————————————————————————————————————————————————————————
6 Past Experience: (use a separate sheet, if necessary) From: ————————— to: ————————————————————————————————————————————————————— Date Date Company name & location Position
Duties performed ————————————————————————————————————————————————————————————
From: ————————— to: ————————————————————————————————————————————————————— Date Date Company name & location Position
Duties performed ————————————————————————————————————————————————————————————
From: ————————— to: ————————————————————————————————————————————————————— Date Date Company name & location Position
Duties performed ————————————————————————————————————————————————————————————
7 References: (3 references, in total, required for full membership) 1. —————————————————————————————————————————————————————————————————— Name Company name Position
——————————————————————————————————————————————————————————————————— Email address or Phone number AES Member Number, if applicable
2. —————————————————————————————————————————————————————————————————— Name Company name Position
——————————————————————————————————————————————————————————————————— Email address or Phone number AES Member Number, if applicable
3. —————————————————————————————————————————————————————————————————— Name Company name Position
——————————————————————————————————————————————————————————————————— Email address or Phone number AES Member Number, if applicable
8 If completing this form after applying for membership online, please quote:
——————————————————————————————————————————————————————————————————— Name AES member no. on online receipt