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)
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