SPE Member Grade Request Form

Use this form to provide us with updated education and work information in order to upgrade your membership status. You will be notified by mail when your member status has been upgraded.

First Name
Last Name
SPE ID#
Birthdate mm/dd/yy		Male      Female

Update the following information and check preferred mailing address.

Work  Home

Business Address

Title
Company Name
Address
Address
City
State/Province
Zip/Postal Code
Country
Work Phone
Fax
E-Mail

Home Address

Address
Address
City
State/Province
Zip/Postal Code
Country
Phone
Fax
E-Mail

Education Data

Please provide information regarding your highest earned degree.

Name of Institution
Year of Graduation(mm/yy)
Degree_Earned

Work Experience

Please provide complete work history information.

Company Name	Employment dates	% of Time Spent in Plastics
	from /   to     /	%
	from /    to     /	%
	from /    to     /	%
	from /    to     /	%
	from /    to     /	%