Member Emeritus Application Application For Member Emeritus Step 1 of 2 50% Name* First Last Home Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Business Address Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Home Phone*Business PhoneEmail* Enter Email Confirm Email Preferred Mailing* Home Business I hereby apply for Member Emeritus classification in VETERANS OF SAFETY. If accepted, I agree to continue to support the cause of human conservation and to lend my experience in furthering the development of the Safety Engineering profession. I further agree to notify the Executive Director promptly of any future changes of address. I will support our National Organization and will honor such assessments as its Board of Directors may in the future deem necessary, but not to exceed half the amount of annual membership dues. Member Emeritus ClassificationDate of Birth* MM slash DD slash YYYY Check whichever of the following applies to you* I have retired from the field of Safety Engineering at the normal retirement age for my company. I am 65 years of age or older but am continuing in partial employment in Safety Engineering. I retired from the field of Safety Engineering due to physical disability. Do you receive pay for Safety Engineering services while in Retirement?* I do not receive pay for Safety Engineering services while in retirement. I receive part time pay for Safety Engineering services while in retirement. 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