Membership Form

Membership valid now through June 30, 2009.

First Name
Last Name
Title
Company
Address
City
State
Zip Code
Phone
Fax
Email

Membership Categories

Individual Membership: $115
Patron Company Membership* plus one Individual: $250
Individual Patron**: $75
Government Employee: $75
Student or Unemployed Professional: $30
  *Patron companies can have one member or many members, even in different locations.  Patron company employees can attend FET functions at the member price; only those listed with the patron company will receive the newsletter.
  **To qualify as an individual patron member, your company must be a patron company.
Prefer Receiving Newsletter by Email  
I am a CHMM, my certification number is

Topics of Interest

Air CHMM Legal Sediment
Waste Training Water Health & Safety
EMS Municipal Redevelopment    

In which geographic area would you most likely attend programs or meetings?

Milwaukee/Southeastern WI Madison/Rockford/South Central WI Wausau/Central Wisconsin
Green Bay/Appleton/Northeastern WI Eau Claire/LaCrosse/Western WI Chicago/Northeastern IL

Please indicate if your company does manufacturing, sales or service activities.
You may choose more than one option by holding down the control button on your keyboard and clicking more than one area.

Manufacturing Services
Sales  
 

Did an FET member encourage you to join?
    If yes, please indicate name:

How did you find FET?

FET Scholarship Donation

 I’m including / authorizing an additional amount as a tax deductible contribution to the FET SCHOLARSHIP FUND.
Please fill in specific amount in the space provided.

Payment Options
You may request to be billed or follow the links to pay with your credit card. 

Invoice  
  Purchase Order # (optional)
  Email (required)
Credit Card  
  After submitting form to FET, you will be asked to click on a link to a "shopping cart".  Please choose the items you are paying for and then view cart to begin your check out.  FET uses PayPal as its secure payment server.