This document contains a student membership application for a high school engineering organization. It requests the student's contact information such as name, date of birth, phone number, email, as well as school name and address. It also contains a section for parental consent that must be completed for students under 18, which acknowledges the organization's privacy policy and allows the student's information to be shared with partners. The application has a section for the student to consent to their information being shared and marketing materials using their image. It also contains the annual dues amount and requires a teacher's contact details.

1. CONTACT INFORMATION
SCHOOL HOME ADDRESS ANNUAL DUES
HIGH SCHOOL STUDENT MEMBERSHIP APPLICATION
PLEASE PRINT:
Name__________________________________________________________________________________________________________________________________
I am a Freshman Sophomore Junior Senior Expected Graduation Date (month/year)_____________________________________
Date of Birth (mm/dd/year) _______________________________________
_
Student Phone (Cell) ___________________________________________ _
Are you 13 years old or older? Yes No
Parent/Guardian Email _________________________________________________
Parent/Guardian Phone ________________________________________________
Please note that in order to provide you with a great experience, we partner from time to time with outside organizations. Please check this box to indicate your consent to our sharing
of your contact information with such partner organizations that relate to your membership in SME.
NOTE: Many member benefits and announcements are distributed electronically. Once you are a member you can update your information at sme.org/update.
School Name:
________________________________________
City_____________________________________
State/Province_____________________________
Address_________________________________
City____________________________________
State/Province____________________________
Zip+4/Postal Code___________________________
__
One-Year Membership $0__________________ $20
Teacher’s Name _____________________________
Teacher’s Email______________________________
Country ________________________________
REQUIRED FOR APPLICANTS UNDER 18 YEARS OF AGE
SME cares about the privacy and personal information of its student members. By execution below, the undersigned hereby (1) represents to SME that s/he is the legal parent/guardian of the student applicant
listed (Applicant), and (2) acknowledges and agrees to the submission of this application and Applicant's potential membership in SME. Personal information contained in this document (and any other information
that might need to be transferred, collected, stored, used, disclosed, or disposed of) will be transferred, collected, stored, used, disclosed, or disposed solely by, of, or to SME for the purpose of processing the
Applicant's application for membership in SME. Additionally, if Applicant is granted membership in SME, such information may continue to be used by SME, including disclosure to SME's business partners in
furtherance of Applicant's membership (provided Applicant has consented to such disclosure by checking the relevant box on this Application). Such consent expressly includes any consent required under the
Family Education Rights and Privacy Act (FERPA) with respect to transfer or use of Applicant's Education records (as such term is defined under FERPA).
Information is prohibited from being disclosed by SME to third parties (except for SME's business partners, provided Applicant has consented to such disclosure by checking the relevant box on this Application).
SME employs commerically reasonable measures to maintain the confidentiality, security, integrity, and accessibility of all information collected on behalf of Applicant, including taking reasonable steps to release
such information only to parties capable of maintaining its confidentiality and security. SME will retain Applicant's personal information, whether collected through hard-copy or electronic submission, for only as long
as necessary to fulfill the purpose for which it was collected, and SME will delete such information using reasonable measures to protect it against unauthorized access or use.
In addition, Applicant and the undersigned hereby agree to the use of company logos, photos and other images that may be used for specified marketing efforts and permit and release SME to utilize such graphics
as agreed upon by Applicant and parent/guardian and SME as part of the SME high school program only. Furthermore, the undersigned hereby approves of, and consents to Applicant's participation in chapter
meetings, and the manner in which Applicant completed this application, including any checked boxes Applicant has checked or left blank.
COMPLETE IF YOUR CHILD IS BETWEEN 13 AND 18 YEARS OF AGE. If your child is under 13 years of age, do not complete this application as your child is not eligible for membership in SME.
PARENT/GUARDIAN PERMISSION FORM PRIVACY STATEMENT
I _______________________________________________________, give my consent for ___________________________________________________
Parent/Guardian Signature _____________________________________________________________________________ Date: ___________________
You will receive the digital edition of
Manufacturing Engineering magazine
manufacturingiscool.com n sme.org/brightminds n smeef.org
©SME 2016_10402
Headquarters use only CODE HSC16
All questions should be directed to Customer Care at 1.800.733.4763 or email service@sme.org. Email form to service@sme.org.
Mail form to SME, Attention: Customer Care, One SME Drive - P.O. Box 930, Dearborn, MI 48121-0930.
Parent/Guardian Name Child's Name
First Middle Initial Last
Parent/Guardian Consent for SME High School Membership
PLEASE NOTE: If you are under 18 years of age, SME cannot process your application without the consent of your parent or guardian. Please be sure to have your parent/guardian review this application and return the signed form to SME.
This form valid through 12/31/2016
Birth year only
®