SBE Membership Application

Required fields are marked with*.

Membership

Please select the appropriate membership category.

 

Category*

Dues

Regular Member

$85 USD

Regular Member with MemberPlus Option

$175 USD

Associate Member

$85 USD

Student Member

$25 USD

Student Member with MemberPlus Option

$90 USD

Reinstatement

Former Member Number:

$85 USD

Change in grade to Member
(for student/youth members only)

$85 USD


Please indicate which chapter you would like to join if your membership application is accepted. (Find a chapter)

If accepted, please enroll me in Local Chapter #

Location

SBE Certification # (if applicable)

Sponsor’s Name/Who introduced you to SBE?

E-voting opt-out

The SBE conducts its annual election of the national board of directors online. To opt out of e-voting and vote by mail instead, check this box.

Contact Information

First Name*

Middle Initial

Last Name*

Mailing Address

Address*

Address - cont

City*

State/Province
(Required of US and Canada members*)

Zip Code/Postal Code*

Country

The above address is:*

Business
Home

Primary Phone* (used for printed and online directories; available only to other SBE members)

Secondary Phone

Fax

Email*

Date of Birth
(MM/DD/YY)

Employment

Place of Employment*

Date Employed*
(MM/YY)

Current Job Title*

Type of Facility*

Description of Duties*

Experience

Total years of responsible Engineering experience:*

Type of experience - check all that apply:

Radio

TV

Other

Experience Record

List in chronological order, beginning with the most recent, all formal experience in Broadcast Engineering or related employment. Indicate field(s) of specialization under “Position.” You must list at least one experience. If a field does not apply, enter "n/a."

From (Mo/Yr)

To (Mo/Yr)

Company Name and Location

Position or Title

Type of Facility


From (Mo/Yr)

To (Mo/Yr)

Company Name and Location

Position or Title

Type of Facility


From (Mo/Yr)

To (Mo/Yr)

Company Name and Location

Position or Title

Type of Facility


From (Mo/Yr)

To (Mo/Yr)

Company Name and Location

Position or Title

Type of Facility

Education*

List in chronological order, beginning with the most recent.

From (Mo/Yr) To (Mo/Yr) College, University, Technical Institute or High School
Course or Major Degree
Number Credits or Years

From (Mo/Yr) To (Mo/Yr) College, University, Technical Institute or High School
Course or Major Degree
Number Credits or Years

From (Mo/Yr) To (Mo/Yr) College, University, Technical Institute or High School
Course or Major Degree
Number Credits or Years

From (Mo/Yr) To (Mo/Yr) College, University, Technical Institute or High School
Course or Major Degree
Number Credits or Years

* If applying for student member status, you must complete the following:

Program/major currently enrolled in:
You are a (check one):
Full-time Student
Part-time Student

Please input the contact information for one of the following: faculty advisor, dean, department chair, registrar, etc. SBE may contact to verify your student status:

Name
Title
Email
Phone

References

List two references who are familiar with your work.

Name
Company Name and Location
Position or Title
Phone

Other Professional Licenses or Certificates

Special Achievements

List awards, patents, books, articles, short courses, seminars related to broadcast-communications technology, etc.

Have you ever been convicted of a felony?*

Yes
No

If yes, describe in full.

 

If approved, I agree to abide by the Society of Broadcast Engineers By-Laws and Canons of Ethics.

Signature*
(typing name constitutes signature)

Billing Information

Billing Address (must be the address associated with the credit card account you are using)

Same as Above Address
OR
Address*:
Address - cont:
City*:
State/Province:
(Required of US and Canada members*)
Zip Code/Postal Code*:
Country*:

Credit Card Information

Credit Card Type*
Credit Card Number*
Expiration Date* (MM/YY)
First Name on Credit Card*
Last Name on Credit Card*
Verification Code*

Visa/Mastercard - The Verification Code is a three-digit number on the back of your credit card. The full credit card number is reprinted in the signature box and at the end of the number is the Verification Code.

American Express - The Verification Code is a four-digit number on the front of the card above the credit card number on either the right or the left side of your American Express credit card.

SBE dues are not deductible as a charitable contribution for federal income tax purposes, but may be deductible as a business expense. SBE estimates that 2% of your dues are not deductible because of SBE’s lobbying activities on behalf of its members.