Senior Membership Application

Please fill out the form below to submit your Senior Membership Application.

CONTACT INFORMATION

Full Name (required)

Nickname

Organization (required)

Mailing Address (required)

City (required)

State (required)

Zip/Postal Code (required)

Country (required)

Business Phone (required)

Home Phone (required)

Fax

E-mail (required)

EDUCATION INFORMATION

Advanced Degrees Held (degree, university, graduation date):

Major:

PROFESSIONAL ACTIVITIES

Member Since (minimum of 5 years required):

Number of years of simulation-related experience:

Number of years of supervisory simulation experience:

Number of years of other experience (please identify):

Other professional society memberships (society, grade, years of membership):

Major simulation publications (particularly those in SCS journals or SCS-sponsored proceedings):

SCS ACTIVITIES

Participation in SCS Regional Councils (year; description):

Participation in SCS Committees (years; description):

Participation in SCS Board of Directors or as National Officer (years; description):

Participation in SCS Editorial Review Board (years; description):

Participation in SCS-sponsored conferences/symposia (years; description):

Participation in NJCC/NCC/AFIPS activities (years; description):

MISCELLANEOUS

Other (patents, honors, awards, etc.):

Comments and Remarks (to be considered in your evaluation):

These two people are familiar with my professional work, and you may contact them in connection with this application. (Please provide complete addresses)

If approved for advancement to Senior Membership Grade Level in SCS, please enter the exact way your name is to appear on certificate. (required)