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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)