Name

First Name

Last Name

Membership Category

Business/Organization Name (if applicable)

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Address Type

Home Address

Business Address

Business #

(###)

###

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EDUCATION (A)

Please list higher education attended & degrees obtained; include dates

EDUCATION (B)

Please list 10 or more wetland related courses (the total number of semester hours must be 30 or greater for active membership consideration)

PROFESSIONAL EXPERIENCE

Please list any State or Federal level wetland-related certifications or licenses (e.g. PWS, LSE, PSS, CWS, etc.). Also, please list special training, publications or knowledge that might assist the Membership Committee.

EMPLOYMENT EXPERIENCE

Experience related to wetlands: please list place(s) of employment, dates, type of work, and percent of time worked in wetlands or wetland related areas. Active membership requires a minimum of two years of full time employment in wetland science

*An advanced degree in a wetland related area may be substituted for up to one year of experience. Please provide specifics. Individuals who do not meet the minimum requirements of education and experience but would still like to apply for active membership may use this space to provide a narrative describing education and special experience that may qualify you for membership.

REFERENCES

Please list at least two professionals who have experience in wetland science and are familiar with your work. Please include addresses and telephone numbers, email addresses or attach letters of reference.