KSEA ONLINE MEMBERSHIP REGISTRATION
Download Printed Form: MS Word file (doc)    Adobe Acrobat file (pdf)
 PERSONAL INFORMATION
*English Name
*Title
*First Name
Middle Name
*Last Name
Korean Name
Korean First Name
Korean Last Name
*Gender
DOB  [mm/dd/yyyy]
*Primary Contact
(Mailing Address)
Street*
 
City*
 
State*
Zip*
*Email
*Telephone
(111-111-1111)
Citizenship
 KSEA CATEGORY
*Member Type KSEA Membership Annual Fee (Term: 46th: 7/1/2017 ~ 6/30/2018)
Regular: $35, Graduate: $15, Undergraduate: Free
   
*Specialty
Main Category: *At least, one specialty is required.
Sub Category:
*1st Choice: 2nd: 3rd:
*Chapter
*Technical
Group
*Affiliated Professional Society (APS)
*Keywords to Represent Your Expertises (e.g. Chemistry, Math, Computer Science)
* Login ID
* Examples: ksea2003, khl2003, finance@ksea.org (MAX 30 characters)
* You will use this login ID to access the information on the ksea.org website.
* password (Max Length = 20)      Confirm
 EDUCATION INFORMATION
*Highest Degree
* For Student, please select your current degree program and type the expected year to earn.
Degree*
Year Earned*
[YYYY]
*Major
*School Name
Thesis Title
 WORK INFORMATION (Student members can enter school information here)
*Affiliation(School Name or Company Name)
Department
 Job Title
 Electronic Signature
Acknowledgement of Electronic Signature I hereby attest that the information provided in this membership application are accurate and I agree and understand that any falsification, omission, or concealment of an individual record may subject me to administrative, civil or criminal liability. I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written signature.
* E-Signature
* - Required Field
 
Korean-American Scientists and Engineers Association(KSEA)
1952 Gallow Road, Suite 300, Vienna, Virginia 22182
Tel: (703) 748-1221, Fax: (703) 748-1331
E-mail: sejong@ksea.org, Web: http://www.ksea.org

© 2010 Korean-American Scientists and Engineers Association. All rights reserved.