Professional Affiliations_________________________________________
__________________________________________________________
__________________________________________________________
Date of Birth_________________________________________________

College ___________________________________________________
Degree____________________________________________________
Date of Graduation____________________________________________

All applicants must include this information.

STUDENT applicants must be full-time. A copy of your college ID or bursar's receipt must be included with this application.

Employment experience: Include employer, position responsibilities, title and date. You may attach a resume instead of using the listing below. Attach additional sheets if necessary:__________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________

Membership services will be received upon payment.
Check enclosed Bill me Bill my company
Charge to my AMEX Visa Mastercard PayPal

Signature of applicant_________________________________________
Account No: ________________________________________________
Exp. Date__________ Amount: $__________________
Name of Sponsor (OPTIONAL)____________________________________
Sponsor IESNA Member No.______________________________________

NOTE: A SPONSOR must be an IESNA member in good standing who supports an individual's application for membership. Having a sponsor is not a prerequisite for membership.  

FOR IESNA OFFICE USE ONLY  Date:
Sec:      Reg:      ABC:     Ind #:

 IMPORTANT INFORMATION
(Please check ONE in each category. Your application cannot be processed without this information.)

Principal business of your firm:
 A. Architecture
 B. Consultant
 C. Lighting Design
 D. Government
 E. Electrical utility, including government owned
 F. Education
 G. Electrical distributor or wholesaler
 H. Electrical contractor
 I. Manufacturer of sources
 J. Manufacturer of luminaires and portable lamps
 K. Manufacturer of lighting accessories or materials
 W. Manufacturer's representative
 L. Interior design
 M. General User (non-lighting mfr., store, theater, etc.)
 N. Other__________
_________________

Your title or position
 O. President, partner, owner, corporate officer
 P. Manager, general, plant, production, etc.
 Q. Lighting engineer, designer or specialist
 R. Engineer, registered
 S. Architect
 T. Independent consultant
 U. Salesperson
 V. Other___________
__________________

Fax to 631-470-0894
Or mail to
IESNA Long Island Section
Sentry Electric LLC
185 Buffalo Avenue
Freeport, New York 11520