Based upon the membership criteria, I hereby make application for admission to the classification of
Checkbox Member   Checkbox Associate  Checkbox Individual Subscribing Member  Checkbox Individual Subscribing Associate  Checkbox Student
CheckboxMs. CheckboxMr.  First Name___________________________ Last Name____________________________ Company___________________________________________________________________________
Address: business/home (circle one) ___________________________________________________________________
Business Phone(    )_______________________________Fax: (    ) _________________________
Home Phone (    )___________________________E-mail___________________________________

Professional Affiliations_________________________________________
Date of Birth_________________________________________________

College ___________________________________________________
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.
CheckboxCheck enclosed CheckboxBill me CheckboxBill my company
Charge to my CheckboxAMEX CheckboxVisa CheckboxMastercard CheckboxPayPal

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.  

Sec:      Reg:      ABC:     Ind #:

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

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

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

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

Paypal Section:

IESNA Membership
Member and Associate: $170.00

  IESNA Membership
Student: $15.00