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	HFES - Houston Chapter New Member Registration

Please fill out this membership registration form so that the chapter will be able to get in touch with you easier.

Once you have entered your information in the spaces below, click on the Submit button at the bottom of the form and your information will be e-mailed directly to the Webmaster for processing. Once received, your own profile web page will be created and listed on the Members page! This information is the same information that is found in the HFES Directory and Yearbook. However, you can decide which information is displayed on our web site by unchecking the box next the field.

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Include?	Field Label	Data
	First Name
	Middle Name or Initial
	Last Name
	Highest Degree
	When Received
	Degree Area
	Where Received
	Second Degree
	When Received
	Degree Area
	Professional Designations
	Home Address
	Home City
	Home State
	Home ZIP
	Home Phone
	Home Email
	Personal Home Page
	Position Title
	Division/Area
	Name of Institution
	Work Address
	Work City
	Work State
	Work ZIP
	Work Phone
	Fax
	Work Email
	Work Home Page
	Areas of Professional Specialization
	Technical Groups
	Society Membership Grade	-- Select -- Associate Fellow Affiliate Member Student Non-member

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Comments.  If you have any comments and/or information that you would like us to know that is not otherwise addressed in the form above, please feel free to enter the information in the space below.