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Women in Science & Engineering

MTSU Membership Application

Identification Information

Last Name__________________ First Name___________________ M.I.

Mailing Address____________________________________________

City/State/Zip Code__________________________________________

Telephone: (___)________________ E-mail:______________________

Current Educational Status

Major:______________________ Minor:_______________________

Year of Graduation:_____________ Current Year (circle one): 1^st 2^nd 3^rd 4^th 5^th

Current Level (circle one): Undergraduate / Graduate / Professional

Membership Fee Schedule

The membership period in MTSU WISE is for one year.

Undergraduate/Graduate Membership Fee

Per year…………………………………………………………………………………….$10.00

Faculty/Professional Membership Fee

Per year…………………………………………………………………………………….$15.00

I hereby apply for membership in  Women in Science & Engineering and I understand that I am eligible to continue my membership as long as I remain within the guidelines of the WISE Constitution and By-Laws. I am submitting the required membership fee along with this application.

Signature___________________ Date__________

T-Shirt Size: ______________________________