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MEMBERSHIP APPLICATION

Society of Reliability Engineers

Buffalo Chapter

P.O. Box 631

Buffalo, NY 14225-0631

I hereby apply for membership in the Society of Reliability Engineers, Buffalo Chapter.

I agree to support the vision, objectives, and working principle of the SRE.

I have included the annual membership fee of $25.00 US, payable to SRE Buffalo Chapter

NAME (please print) _____________________________________

Title (optional) _____________________________________

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Please send SRE mail to: _____ Business address ____ Residence (check one)

Please send SRE mail by _______US Postal Service ______ e-mail (check one)

Applicant's signature : _________________________ Date: ____________

Mail to above letterhead address with your check for $25