REGISTRATION FORM - American Society of Civil Engineers



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PE Civil Exam Review Course – Spring 2016

Registration Form

Location: Tennessee Engineering Center, Nashville

Schedule: Monday evenings from 6-8:30 pm, between February 1nd and April 4th, 2016

Recommended

Materials: PE Civil Reference Manual, Lindeburg (13th edition)

Practice Problems for the Civil PE Exam, Lindeburg (13th edition)

Civil PE Sample Exam, Lindeburg (3rd edition)

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Registrant Information (please print):

First Name: Last Name:

Company:

Mailing Address:

City, State, Zip:

Phone Number: Email Address:

Cell Phone: ________________________________Preferred Method of Contact: ______________________

Payment Information – books not included in price

Registration:  ASCE, TSPE or ACEC Member $350 Member #

 Non-Member $550

 Individual session for PE member $100 Member #____________Date

 Individual session for PE Non-Member $150 Date

All registrations must be received by Buddy Burks no later than January 26, 2016 to reserve your class space. Payment may be mailed with registration form or brought to the first class (February 2nd). Failure to meet these deadlines may result in loss of reserved space.

Email: buddy_burks@

Mail: Buddy Burks

511 Union St, Suite 1400

(Make Checks out to Nashville, TN 37212

ASCE – Nashville Branch)

NOTE: ASCE reserves the right to cancel a complete course or an individual course offering in case of inadequate enrollment or in case of an emergency or natural disaster. In the case of inadequate enrollment, ASCE will notify registered participants prior to the scheduled start date and issue a full refund to the participant. In the case of a cancellation because of an emergency or natural disaster, ASCE will notify all participants when possible, and reschedule the course offering for another date closest to the original date as possible.

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