This transcription has been completed. Contact us with corrections.
[[image]] OFFICE RECORD No Rec'd Ack Elec Grade Qual Pin Cert Tr. Yr Rein INSTITUTE OF THE AERONAUTICAL SCIENCES 2 EAST 64TH STREET NEW YORK 21., N.Y. APPLICATION FOR MEMBERSHIP To the Membership Committee of the Institute of the Aeronautical Sciences: I hereby apply for membership in the Institute of Aeronautical Sciences. The information given on the application is true and correct to the best of my knowledge and belief. The references listed are personally familiar with my aeronautical activities. I agree to conform to the Constitution and By-Laws, and the rules of the Institute. If my membership terminates for any reason, I will not use the initials of the Institute after my name and will return, on request, any certificate or insignia of membership. Date Signature in full (SIGN WITH PEN - DO NOT USE INITIALS) BIOGRAPHICAL RECORD (PLEASE FILL IN ALL INFORMATION BY HAND LETTERING OR TYPEWRITER) PRINT TITLE AND NAME AS PREFERRED FOR MAIL ADDRESS PREFERRED FOR MAIL AND PUBLICATIONS OF THE INSTITUTE PRINT NAME EXACTLY AS YOU WISH IT TO APPEAR ON YOUR MEMBERSHIP CERTIFICATE LIST PERMANENT HOME ADDRESS, IF BUSINESS ADDRESS IS GIVEN ABOVE PLACE AND MONTH, DAY AND YEAR OF BIRTH COUNTRY OF CITIZENSHIP (IF NATURALIZED, GIVE PLACE AND DATE) COMPANY OR ORGANIZATION WITH WHICH YOU ARE CONNECTED ADDRESS YOUR TITLE OR POSITION PRODUCTS OR SERVICES OF THE COMPANY OR ORGANIZATION NATURE OF YOUR DUTIES, OR YOUR PROFESSION OR OCCUPATION IF YOU ARE A LICENSED OR REGISTERED ENGINEER OR OTHER PROFESSIONAL SPECIALIST, GIVE TITLE OF SUCH LICENSE AND STATE IN WHICH REGISTERED GRADE AND NUMBER OF PILOT CERTIFICATE HELD, IF ANY IF BIOGRAPHY HAS BEEN PUBLISHED, WHERE? AWARDS, FELLOWSHIPS, SCHOLARSHIPS OR OTHER HONORS RECEIVED. (GIVE DATES AND CITATIONS) NAMES OF TECHNICAL AND AERONAUTICAL ORGANIZATIONS IN WHICH YOU HAVE MEMBERSHIP AND GRADE OF SUCH MEMBERSHIP IF MEMBERSHIP IN THE INSTITUTE WAS PREVIOUSLY HELD, STATE GRADE AND DATE OF RESIGNATION TITLES OF TECHNICAL CONTRIBUTIONS, PARTICULARLY AERONAUTICAL: WHEN AND WHERE PRESENTED OR PRINTED. IF THE LIST IS EXTENSIVE, PLACE INFORMATION ON SUPPLEMENTAL SHEET OF THIS SIZE. THIS QUALIFICATION IS GIVEN SPECIAL CONSIDERATION BY THE MEMBERSHIP COMMITTEE. BRIEF STATEMENT OF SPECIAL AERONAUTICAL QUALIFICATIONS (PLEASE FURNISH ADDITIONAL DATA REQUIRED ON REVERSE SIDE OF THIS FORM)