After you have submitted your form, PRINT and RETURN to the address listed at the bottom.

I have reviewed the information provided in this request and find it to be accurate to the best of my knowledge.

___________________________________________________ ________________________________
(Signature) -----------------------------------------------------------------------------(Title)

Please return this form with $50 to:

Montana Society of Engineers
Connie Dempster, Executive Secretary
PO Box 20996
Billings, MT 59104-0996
For other inquiries:
Phone:  406-259-7300
Fax:       406-259-4211
E-mail: mse@assoc-mgt.com