Corporate Delegates

Please complete both sides of this form.

1 32Name

Mailing Address

City, State, Zip

Country

Business Phone

Business Fax

Business E-mail Address

Cell Phone

Home Phone

Home E-mail Address

Date of Birth (mm/dd/yyyy)

Section

Please clearly print any changes to information shown here. Preferred E-mail adress : Business Home

ASNT Corporate Partners are entitled to three delegate memberships. Each delegate receives a subscription to Materials Evaluation, ASNT’smonthly journal and The NDT Technician, a quarterly newsletter. If the delegates listed below are incorrect or have changed, please indicatechanges below or attach a business card. Please be sure to include each delegate’s e-mail address.

Complete both sides of this form and return with payment to The American Society for Nondestructive Testing, Inc.,PO Box 28518, Columbus OH 43228-0518; Or renew: Online www.asnt.org, Fax 614.274.6899, Phone 614.274.6003 or800.222.2768 US/Canada. Federal ID# 31-1231529.

Name

Mailing Address

City, State, Zip

Country

Business Phone

Business Fax

Business E-mail Address

Cell Phone

Home Phone

Home E-mail Address

Date of Birth (mm/dd/yyyy)

Section

Name

Mailing Address

City, State, Zip

Country

Business Phone

Business Fax

Business E-mail Address

Cell Phone

Home Phone

Home E-mail Address

Date of Birth (mm/dd/yyyy)

Section

1/18 Inhouse

Payment Information Total Amount Paid $

AmEx MasterCard Visa Discover Check1 Funds TransferForm of Payment

Account Number

Name on Card (Print please)

Signature

Credit Card Billing Address

Alternate Email Address for Receipt

Exp. Date

Address, City, State, Zip, Country

CIN*

* Credit Card Identification Number. For Visa/MasterCard/Discover: The three-digit value is printed on the signature panel on the back of cards immediately following the account number. For American Express: 4 digit, non-embossed number printed above your account number on the face of your card.

1 Checks must be drawn on United States bank and U.S. dollars

Materials EvaluationRNDE

Airmail Fee for Members Outside North America* (optional)

$48 × number of subscriptions (1–4) _____ = Total $________$74 × number of subscriptions (1–4) _____ = Total $________

Unless airmail is specified, all materials will be sent sea/surface mail; allow 3-4 months for delivery.

1 Year Corporate Partner Dues

Research in Nondestructive Evaluation (RNDE®) Individual Subscription(s)

RNDE is ASNT’s quarterly research journal.Print Subscription — for current volumeElectronic Subscription — for current volumePrint and Electronic Subscription — a savings of $35

$65 × number of subscriptions (1–4) ____ = Total $__________$65 × number of subscriptions (1–4) ____ = Total $__________$85 × number of subscriptions (1–4) ____ = Total $__________

Please indicate who is to receive RNDE subscription(s) Company Delegate 1 Delegate 2 Delegate 3

Send Materials Evaluation via Airmail to: Company Delegate 1 Delegate 2 Delegate 3Send RNDE via Airmail to: Company Delegate 1 Delegate 2 Delegate 3

5. Which SIC or NAICS codes are used to classify your company?

Company Profile1. Number of people involved with NDT at your company

1–5 6–20 21–50 51–100 over 1004. Check the one business industry segment that best

describes your company. (check only one)

NDT Utilization BusinessAerospace/Aviation/Aircraft MedicalAmusement Rides & Skiing NuclearAutomotive OpticalChemical & Petroleum OrdnanceConstruction PipelineCommercial Labs Pulp/PaperInfrastructure (Roads & Bridges) RailroadElectronics Semi ConductorMarine Utilities

NDT Supplier BusinessConsulting RoboticsDistributor/Manufacturers’ Supplies

Representative TrainingEquipment Computer SoftwareResearch Computer Hardware

2. With which NDT method(s) does your company perform?(check all that apply)

Acoustic Emission Liquid PenetrantAlternating Current Magnetic Flux Leakage

Field Measurement Magnetic ParticleElectromagnetic/Eddy Current Neutron RadiographyGround Penetrating Radar RadiographyInfrared & Thermal UltrasonicsLaser Vibration AnalysisLeak Visual

3. Choose the primary type of application of NDT that your company does? (check only one)

Design and Failure AnalysisField InspectionIncoming InspectionIn-service, Plant/Operation Maintenance & Process ControlProduct Life ExtensionQA/QC ReliabilityNone of the above

ASNT Corporate Partner affiliation is nontransferable & nonrefundable.Rates quoted are good for six months after expiration date.

Note: All pricing subject to change.

Company Name:

*Airmail service is restricted by availability and cost. Airmail may not be available in your country.ATTENTION residents of Iran and Nigeria Airmail is not available in your country.