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P I P E L I N EA S P E A T L A N T A
A P R I L 2 0 1 7
A non-profit organization.
Local chapters are not authorized
to speak for The Society.
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PRESIDENT'S CORNEROV ID IU MURESAN , CPD , LEED AP
As many of you know, the 2018 ASPE National Convention will
be in Atlanta. It is going to be a lot of work for our chapter. If
you’re willing to help please contact Harry Schnirring our
committee chair.
We are in the process of changing the CVENT registration
system with a web based system by StarChapter. Until the end
of the year we will run both systems in parallel to avoid any
disturbance. There is a good progress in implementing the new
system.
The Board is continuing the program to help young
professionals join ASPE. If you’re a young professional
plumbing engineer and you want to join ASPE please let me
know we may be able to help.
Don’t hesitate to contact me with any questions at
Please, email me directly with any questions and/or
suggestions and I’ll try to answer them. If some of the topics
become hot items we’ll have an open forum, and discuss them
at our monthly meetings.
Thanks,
Ovi Muresan CPD, LEED AP
May 23rd is our last monthly meeting of the 2016-2017
year. Please plan to attend and vote for the new board.
During the months of Summer, the board will continue to
meet every month to plan the 2017-2018 ASPE Atlanta
Chapter events. There is a long list: monthly meetings,
Golf outing, ASPE Technical Symposium, Product Show,
Skeet Shoot and others.
PAGE 1 MAY 2017PIPELINE
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VP TECHNICALDENNIS M . CONNELLY , CPD
It was distributed by ASPE in one of their regular membership e-
mail contacts. These are very informative and give insight into NSF
certifications and their relationship to plumbing codes and
standards engineers and contractors use everyday. Be on the
lookout for these documents and other news from Society in your
e-mailbox.
In our last program of the year, we will hear a presentation about
special materials used in specific applications. Our presentation
will explore stainless steel drainage systems for food and beverage
production facilities, and, how that can be used to reduce the
potential for contamination of products and national product
recalls.
The year has moved quickly and I hope that you have been
pleased by the work we have done this year. My personal
goal has been to offer meaningful, valuable programs for your
enjoyment and technical growth. As this is our last meeting
coming, we can only continue that quest next activity year.
Until then, or at your convenience, please feel free to reach
out to me and share your thoughts and ideas for programs or
activities you would like to see, and I will work to make them
happen.
The year has moved quickly and I hope that you have been
pleased by the work we have done this year. My personal
goal has been to offer meaningful, valuable programs for your
enjoyment and technical growth.
Greetings Plumbing friends and professionals
everywhere;
May is here and the weather is wonderful. We are finally,
fully into spring and moving through the calendar
briskly. Already many colleges and universities have
completed graduation ceremonies, and our high-school
students are coming up quickly. We are also
approaching our last event in our chapter activity year.
PAGE 2 MAY 2017PIPELINE
As this is our last meeting coming, we can only continue that quest
next activity year. Until then, or at your convenience, please feel
free to reach out to me and share your thoughts and ideas for
programs or activities you would like to see, and I will work to make
them happen.
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Our speaker will be Mr. James Hunt with Watts Water, who
will speak about Blücher drainage systems. I hope to see
many of you there for an interesting presentation.
Since we won’t be meeting this summer, I would like to leave
you with another piece of plumbing history to enjoy and
inspire you until the fall. This was originally shared with me by
the Society VPT David DeBord. It is a bit long for lunchtime
viewing, but well worth the watch after hours. Enjoy!
https://www.youtube.com/watch?v=nhkxD6bD2AY
Wishing you all a great summer! Work hard – play hard –
have fun! See you in September!
Dennis M. Connelly CPD
VP Technical
PAGE 3 MAY 2017PIPELINE
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眀眀眀⸀稀漀攀氀氀攀爀瀀甀洀瀀猀⸀挀漀洀娀漀攀氀氀攀爀 䘀愀洀椀氀礀 伀昀 圀愀琀攀爀 匀漀氀甀琀椀漀渀猀吀䴀
㠀 ⴀ㐀 ⴀ㐀㠀㜀
䬀䔀䔀倀 䤀吀 䌀䰀䔀䄀一℀伀䤀䰀 䜀唀䄀刀䐀글 匀夀匀吀䔀䴀
倀刀伀吀䔀䌀吀匀 䔀一嘀䤀刀伀一䴀䔀一吀☀ 䔀儀唀䤀倀䴀䔀一吀
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VP MEMBERSHIPDAV ID COLA IACOVO , CPD , GPD
Atlanta ASPE Chapter membership is doing well. We are above the 200 member mark holding steady at 207 members.
I personally believe we stand above others because the Atlanta ASPE Board focuses specifically on providing our
members with a valuable service. A service we are to provide by:
PAGE 4 MAY 2017PIPELINE
Keeping our members up-to-date on current trends, code changes, and technologies affecting the plumbing
engineering industry;
Providing our members with direct access to the latest information and technical developments in the field;
Offering education and professional growth and development opportunities;
Maintaining a Chapter network that enables our members to build personal and professional contacts and to network
with engineers, designers, wholesalers, and manufacturers. It makes for a unique opportunity for peer-to-peer and
professional-to-professional interaction in an informal and friendly setting.
Do you have a colleague or friend that could benefit from such services? If so, I challenge you to bring them to our next dinner
meeting.
As always, members are the backbone of our Chapter and Society. The more members we have, the more value WE create. We
are constantly probing for new ideas in regards to increasing membership and involvement in the Atlanta Chapter. Please feel free
to contact me with any suggestions you may have. My phone number is 770-414-1628, and my email address is
The first annual ASPE Skeet Shoot was a success, I would like to thank everyone who sponsored this event and all who showed up
to shoot. Thanks to Tom Low Shooting range and Beaver Creek BBQ (man that BBQ was good)!
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VP EDUCATIONCARL GAROFALO
As we wrap up another year in ASPE, and the end of my tenure with the ASPE board, I am reminded why I value my membership
so much. ASPE is a great organization for furthering industry knowledge, networking, and staying current with codes and statutes
that affect our field. I have many great friendships and working relationships that were born out of ASPE, and consider the yearly
dues and dinner meeting fees a very small investment when you consider the value that is derived from the program. I look forward
to next (ASPE) year, and will see everyone at the ASPE golf tournament. Thanks to everyone for attending the meetings,
participating in member events, and reading our newsletter! Speaking of reading the newsletter, I have been writing articles for
years now and have always wondered how many people read this thing! To reward readership and to satisfy my personal curiosity,
please send an email to [email protected] with the subject line ASPE. I’ll raffle off a box of Titleist NXT Tour balls
amongst the participants that emailed me (you must attend an Atlanta ASPE dinner meeting or event to accept the prize). Thanks!
PAGE 5 MAY 2017PIPELINE
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M a k e s u r e t o c h e c k o u t
t h i s m o n t h ’ s i s s u e o f
P l u m b i n g E n g i n e e r
M a g a z i n e .
F o r m o r e i n f o r m a t i o n ,
v i s i t t h e i r w e b s i t e :
w w w . p l u m b i n g e n g i n e e r . c o m
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A H A C O N S U L T I N G E N G I N E E R S
3 7 0 0 M A N S E L L R D . , S U I T E 2 0 0 , A L P H A R E T T A , G A 3 0 0 2 2
P H O N E : 7 7 0 . 9 9 2 . 8 5 8 5 F A X : 7 7 0 . 9 9 2 . 6 9 0 2 E M A I L : H E N S O N C @ A H A - E N G I N E E R S . C O M
C A R O T E K
3 0 K E L L I C L A R K C O U R T S E , C A R T E R S V I L L E , G A 3 0 1 2 1
P H O N E : 7 7 0 . 6 3 0 . 3 1 0 0 E M A I L : R I C H A R D . G O O D N I G H T @ C A R O T E K . C O M
W E B S I T E : W W W . C A R O T E K . C O M
C O L E M A N - R U S S E L L & A S S O C I A T E S , I N C .
4 6 7 5 G R A N I T E D R I V E , T U C K E R , G A 3 0 0 8 4
P H O N E : 2 0 5 . 8 3 3 . 0 7 0 0 F A X : 2 0 5 . 8 3 6 . 6 5 2 8 E M A I L : J U S T I N . K A Y @ C O L E M A N R U S S E L L . C O M
E Q U I P M E N T C O N T R O L S C O M P A N Y
6 0 5 C O M M E R C E P A R K D R S E , M A R I E T T A , G A 3 0 0 6 0
P H O N E : 7 7 0 . 4 2 7 . 8 7 7 6 E M A I L : A B L O N G @ E Q U I P M E N T C O N T R O L S . C O M
G E O R G I A W A T E R T A N K S , L L C
3 5 7 7 C H A M B L E E T U C K E R R D . , S U I T E A 2 2 3
P H O N E : 4 0 4 . 9 9 1 . 0 4 0 4 E M A I L : R D H A N S O N @ G E O R G I A W A T E R T A N K S . C O M
W E B S I T E : W W W . G E O R G I A W A T E R T A N K S . C O M
C O P P E R D E V E L O P M E N T
5 0 2 0 C L A R K R D . S U I T E 3 3 2 5
P H O N E : 4 0 4 . 3 7 3 . 0 3 2 4 E M A I L : L A R R Y . P E T E R S @ C O P P E R A L L I A N C E . U S
H A R R Y W A R R E N O F G E O R G I A , L L C
2 8 6 1 B A N K E R S I N D U S T R I A L D R . , S U I T E B , D O R A V I L L E , G A 3 0 3 6 0
P H O N E : 6 7 8 . 5 1 6 . 0 3 7 7 E M A I L : R Y A N B A R N E S @ H A R R Y W A R R E N . C O M
H D R A T L A N T A
1 1 0 0 P E A C H T R E E S T N E , S U I T E 4 0 0 , A T L A N T A , G A 3 0 3 0 9
P H O N E : 4 0 4 . 6 0 1 . 8 6 0 0 E M A I L : J O S E P H . M E S S I N A @ H D R I N C . C O M
M A T H E S O N - B A L L & A S S O C I A T E S
1 1 2 8 5 E L K I N S R D , S U I T E F 3 , R O S W E L L , G A 3 0 0 7 6
P H O N E : 7 7 0 - 7 5 1 - 0 7 7 3 E M A I L : D E S I G N @ M A T H E S O N B A L L . C O M
S PONS ORS
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M C W A N E P L U M B I N G G R O U P
P H O N E : 9 2 5 . 2 1 6 . 1 8 2 8
R E P C O S A L E S O F G E O R G I A
2 1 1 R O P E M I L L P A R K W A Y
P H O N E : 7 7 0 . 5 9 1 . 1 8 0 0 C E L L : 4 0 4 . 6 9 7 . 4 4 1 0 E M A I L : A T C H C A P T A I N @ A O L . C O M
W E B S I T E : W W W . R E P C O S A L E S O F G A . C O M
S O U T H E R N S P E C
2 1 2 5 C O R P O R A T E D R I V E , S U I T E 1 0 5 A , M A R I E T T A , G A 3 0 0 6 7
P H O N E : 7 7 0 . 6 2 7 . 5 4 5 8 E M A I L : J O E . S O M E R V I L L E @ S O U T H E R N S P E C . C O M
S P O T S W O O D , C O T T O N & W E L S H , I N C .
6 2 3 5 A T L A N T I C B L V D . , N O R C R O S S , G A 3 0 0 7 1
P H O N E : 7 7 0 . 4 4 7 . 1 2 2 7 E M A I L : J O E W E L S H @ S C W S H L E S . C O M
T H E R M A L
R E S O U R C E
S A L E S
1 2 1 B R I A N D W O O D D R . , N E W M A N , G A 3 0 2 6 5
P H O N E : 3 0 9 . 3 3 9 . 5 5 5 5 E M A I L : J O S H . L O W E @ T R S - S E S C O . C O M
U N I T E D S A L E S A G E N C Y
3 1 6 A L E X A N D E R S T . , S U I T E 7 , M A R I E T T A , G A 3 0 0 6 0
P H O N E : 7 7 0 . 5 1 4 . 7 4 4 4 E M A I L : D O U G D Y S O N @ B E L L S O U T H . N E T
W H I T E W O L F G R O U P , I N C .
P H O N E : 4 0 4 . 3 1 2 . 6 1 9 0 E M A I L : Z A C K . H U D G I N S @ W H I T E W O L F G R O U P I N C . C O M
S PONS ORS
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John J. Bertrand James G. Blake III P.E., CPD
Edward F Buhler P.E. Caroline C. Calloway
John W Campbell Jeffrey A. Ford CPD
Michael E. Fox L Carl Matthew Garofalo G.E.
Richard Jernigan P.E. Michael Kicher CPD, LEED AP
Robert Anthony Lastinger Robert M. Maddox P.E.
John E. Mays III Matthew Ryan Mercer
Luther L. Morgan Jr., P.E. Keith M. Nix P.E. Clay L. Peacock
Timothy W. Pemberton Christopher Rohling Jiles A. Singleton P.E
M A Y 2 0 1 7A N N I V E R S A R I E S
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B I R T H D A Y S
Jim Allen LEED AP Ryan Barnes
Timothy M. Bollwerk Lata Anil Chandnani G.E., CPD
Mike Doychak Jeffrey A. Ford CPD
Kenney Shane Hamby Matthew Frank Harrison
Brandon Michael Pangrazio G.E. Timothy W. Pemberton Jiles A. Singleton P.E
Jesper Ulf Sjogren John Charles Underwood
Ronald Scott Wilhelm Paul Carl Winstead
M A Y 2 0 1 7
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2017 SALES/MARKETING OPPORTUNITIES The Atlanta Chapter Board is announcing four different types of opportunities for reps and/or manufacturers wanting to
promote their company and/or product lines: 1). newsletter sponsorship:
$100; Company listings appears in each of 12 monthly issues. 2). newsletter insert:
$125 Single page Insert appears in one (1) issue. $45 Single 1/4 page Ad in one (1) issue.
3). MONTHLY MEETING TABLE TOP DISPLAY: $100/meeting
4). ASPE Atlanta Chapter Product Show: $550/Booth ASPE Members
$750/Booth Non-ASPE Members. 2015 SALES/MARKETING OPPORTUNITIES
Typically the fourth Tuesday of each month September—May
Social--------------------- 6-7 pm Dinner----------------- 7-7:30 pm
Business ----------- 7:30-7:45 pm Program------------ 7:45-8:45 pm
Dinner Prices Members pre-registration: $35
Members at the door: $40 Non-Members pre-registration: $40
Non-Members at the door: $45
CANDIDATES FOR ELECTIVE OFFICE 2017/2018
PRESIDENT OVIDIU MURESAN, CPD, LEED® AP
VICE PRESIDENT TECHNICAL DENNIS M. CONNELLY, CPD
VICE PRESIDENT LEGISLATIVE
JOSEPH V. MESSINA, CPD, FASPE
VICE PRESIDENT MEMBERSHIP DAVID COLAIACOVO, CPD, GPD
VICE PRESIDENT EDUCATION
STEPHEN E. HOWE, PE
TREASURER JOSH FLANNIGAN
ADMINISTRATIVE SECRETARY
CHARBLRES TRAYLORS
CORRESPONDING SECRETARY L. DIEDRICH SMAY, JR.
APPOINTED OFFICERS
CHAIRMAN, BOARD OF GOVERNOR
JOSEPH V. MESSINA, CPD, FASPE NEWSLETTER EDITOR
JONATHAN ASLAN CHAPTER HISTORIAN JULIE HADFIELD, E.I.T.
AFFILIATE LIAISON RYAN BARNES
SOCIAL MEDIA COORDINATOR JULIE HADFIELD, E.I.T.
ASPE YOUNG PROFESSIONAL LIAISON JASMINE KINARD
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AMERICAN SOCIETY OF PLUMBING ENGINEERS6400 Shafer Court • Rosemont, IL 60018–4914
(847) 296-0002 • Fax: (847) 296-2963E-mail: [email protected] • www.aspe.orgMEMBERSHIP APPLICATION
(Please Print or Type)
CERTIfICATION By APPLICANTThe undersigned certifies that all statements made herein are correct and, if elected to the Society, agrees to adhere to the Society’s Bylaws and accept the Classification conferred by the Society. Upon becoming a member, the applicant will endeavor to advance the objectives of the Society and the plumbing engineering profession.
*Classification of Firm A - Arch./Engr. or Cons. Engr. B - Govt. Agency C - Mfr. or Mfr’s. Rep. D - Educ. Inst. E - Contractor F - Other (Explain) _____________________________________
REFERENCES (References should be in engineering profession. ASPE members preferred. ASPE reserves the right to contact references.)
Name Address Telephone
PROFESSIONAL EXPERIENCE ( This section must be completed as it affects membership grade classification. List chronologically, beginning with the present. Work description must be clear and concise: e.g., plumbing, piping, fire protection, HVAC, etc. Use additional sheet as necessary.)
Signature of Applicant Date
© Copyright 2013 American Society of Plumbing Engineers. All Rights Reserved.
I wish to affiliate with the Chapter.
First Name (Nickname) Middle Name Last Name
Birth Date: M /D /Y _ Check all that apply: ❏ P.E. ❏ P. Eng ❏ CPD ❏ Graduate Engineer ❏ LEED AP ❏ CET ❏ Other ____________________
Certification (P.E.) State Certificate No. Branch
❏ Mr. ❏ Ms. ❏ Miss ❏ Mrs.
Name of Institution Course or Major From To Graduation Date Degree/Diploma
High School
College/University
Technical School
Others
EDUCATIONAL RECORD
From To Firm Name and AddressClass*
(see below) Title Description of WorkDegree of
ResponsibilityDate(Mo/Yr)
Chapter Use Only
HQN07
American Society of Plumbing Engineers member dues are nonrefundable and not deductible as a charitable expense, but may be deductible as a business expense.* Contributions to ASPE Education (create education programs for membership) and Alfred Steele Scholarship (to award college scholarships) Funds are Strictly
Voluntary and are not deductible as a charitable contribution but may be duductible as an ordinary and necessary business expense. ** Contributions to the ASPE Research Foundation are Strictly Voluntary and are tax deductible as a charitable contribution.
INCOmPLETE APPLICATIONS wILL NOT bE PROCESSED.
Sponsor(Please Print)
RESIDENCE: Street Address City State ZIP Phone
E-mail (required) Business E-mail Cell Phone
BUSINESS: Organization Name Your Title Phone Fax
Street Address City State ZIP
Other oganizations you are a member of: ❏ ASHRAE ❏ ASSE ❏ NFPA ❏ NSPE ❏ ASME ❏ PHCC ❏ ICC ❏ IAPMO ❏ SFPE ❏ Other _________________________________________________
Preferred Mailing Address ❏ RESIdENCE ❏ BuSINESS
PLUmbINg ENgINEERINg DESIgN HANDbOOkNew members receive one of four volumes of the this definitive collection of general plumbing practices. As an ASPE member you will be sent the CD-rom un-less you indicate preference for the softcover edition. If you would like both the CD-rom and softcover editions, please add $50 to your total to the right.
❏ Cd-ROM ❏ SOfTCOVER
Payment Information:❏ Enclosed is my check payable to ASPE.Please charge my: ❏ Visa, MasterCard ❏ discover ❏ American Express
Card #________________________________
Exp Date: ________________
Signature: _____________________________
date: ________ Telephone: ______________
REMIT MEMBERSHIP duES wITH APPLICATION
Member Type AmountAmount due(Enter Amount)
❑ Full $190 $
❑ Associate $170 $
❑ Affiliate $190 $
❑ Special $190 $
❑ Governmental $190 $
❑ Student $ 30 $
❑ PEDH CD & Book $ 50 $
❑ ASPE Alfred SteeleScholarship Fund* $ 25 $
❑ ASPE Education Program Fund* $ 25 $
❑ ASPE ResearchFoundation** $ 25 $
TOTAL AMOuNT duE $
Promo CODE: MBR2011
How did you hear about ASPE? ❏ Past Member ❏ Plumbing Engineer Magazine ❏ Colleague/Employer ❏ ASPE App ❏ Website
❏ Other _____________________________________
EDUCATION
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© Copyright 2013 American Society of Plumbing Engineers. All Rights Reserved.
Immediate Member BenefitsThe Plumbing Engineering Design Handbook: The most definitive col-lection of general plumbing practices in the field of plumbing engineer-ing. The ASPE Handbook consists of forty-seven chapters divided into four volumes. New members receive one of four volumes immediately upon joining and the revised volume thereafter.
Plumbing Engineer Magazine: Members immediately begin receiving Plumbing Engineer magazine. This monthly magazine covers a wide spec-trum of topics important to the profession and to daily practices in the field.
The ASPE Report: The Society’s bimonthly newsletter, incorporated with-in the Plumbing Systems & Design magazine, keeps members abreast of Society activities and issues impacting the profession.
Publication and Education Program Discounts: All publications, educa-tion programs, and other services and products of the Society are offered at special discounted rates to ASPE members.
Collegial Interaction and NetworkingEvery ASPE member not only belongs to ASPE worldwide, but has the opportunity to belong to one of 62 Chapters organized throughout the United States and Canada. Chapters sponsor seminars, conduct monthly technical meetings, publish newsletters and offer special peer-to-peer and professional-to-professional interaction and networking opportuni-ties.
Professional Growth and DevelopmentThe ASPE Biennial Convention and Engineered Plumbing Exposi-tion (EPE) is the premier educational and professional development event for plumbing engineers and designers. The Convention features a comprehensive program of educational, technical and professional de-velopment presentations and seminars designed to enhance professional knowledge and foster awareness of new techniques. The concurrent EPE is the largest Exposition dedicated entirely to the field of plumbing engineering.
The ASPE Technical Symposium is offered in non-Convention years and provides a unique forum for the most comprehensive and intensive half-day and full-day plumbing engineering design seminars and workshops avail-able anywhere. The “hands-on” workshops provide the plumbing engineer with information about new developments in the industry and new techniques for practical implementation in the field.
Technical Seminars and Workshops sponsored by ASPE offer one- or two-day programs conducted by leading industry professionals. Each educational program focuses on a specific area of plumbing engineering.
Continuing Education Units (CEUs): ASPE offers the opportunity to earn Continuing Education Units at selected technical program sessions at the biennial Convention, the Technical Symposium and at stand-alone Seminars and Workshops. CEUs are nationally recognized units of achievement that may be used as evidence of increased performance capabilities and for job advancement.The Society shall be open to anyone involved in, or having a special inter-est in, the design, specification or drawing of plumbing systems.
Dues: Please choose the appropriate membership classification and remit dues with this application. In the event the membership classification is changed, a corrected dues statement (or dues overpayment refund) will be sent with your notice of election.
Membership ClassificationsMembership classification (Grade) will be conferred based on Article II of the ASPE Bylaws as follows:
Full Member: Eight (8) years of experience in plumbing engineering or related engineering field, a minimum of four (4) years of which must have been in a position of responsibility for the design of plumbing systems or in a position of responsibility for the design of systems and components related to, or incorporated within, plumbing engineered and designed systems. A maximum of four (4) years of experience may be waived by the Society Membership Committee for: (a) Education: one-half (1/2) year for each completed year in a curriculum related to plumb-ing engineering; (b) Engineering Registration: four (4) years for Profes-sional Engineer registration in a field that includes plumbing engineering; (c) CPD certification: two (2) years. Dues: $190.
Associate Member: Professionals engaged in plumbing design as con-sultants or engineers with fewer than eight years of industry experience. Dues: $170.
Affiliate Member: Any individual involved in the production or market-ing of plumbing products. Dues: $190.
Retired Member: Any retired member with ten (10) years of continuous membership in the Society who has reached the age of sixty (60) years and is no longer active in the profession. Members in this category will not receive Plumbing Engineering Design Handbook materials and shall pay substantially reduced annual dues. Dues: $40.
Special Member: Professionals in related fields, such as contractors, or those with a special interest in plumbing design whose professional back-ground do not match the requirements for any of the other categories may apply for Special membership. Dues: $190.
Governmental Member: Anyone employed by municipal, state, or federal governments for one of the following reasons:A. Checking and/or inspection of plumbing plans and installations;B. The formulation of codes, rules, requirements and regulations pertain-
ing to the planning, designing and installation of plumbing systems, orany portion of a plumbing system;
C. Research and development of plumbing systems design criteria. Excep-tion: Persons employed by a government agency for the purpose ofdesigning and/or specifying plumbing systems, who shall be eligibleto be Full or Associate members, provided they have fulfilled theexperience required as outlined for each respective classification. Dues:$190.
Student Member: Any individual attending a recognized university, col-lege, community college, vocational, or technical trade school full time or part time in a curriculum related to plumbing design. Student Members are considered to be an introductory level to the Society. Student mem-bership shall be limited to five (5) years after which time the membership shall be upgraded to an applicable membership classification as deemed appropriate by the Society. Other member classifications shall not be permitted to downgrade to a Student Member classification. Dues: $30.
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to abide by the conditions stated herein.
Name(First) (Middle) (Last)
(Zip Code)(State)
Residence Address(Street Address)
(City)
(Telephone Number with Area Code) (E-mail Address)(Fax Number with Area Code)
ment and waiver of the Society dues for the period stated herein.
Signature of Member Date
± HaveI ± Have not previously applied for Compassion Dues Waiver from theSociety.
Time Period for Dues Deferment: From: ______________ To: ______________
May not exceed a three (3)-month time period.
Month/Day/Year Month/Day/Year
Reason for Request
Signature of Chapter President (Society Vice-President, Membership) Date