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NABIE Membership Registration Form

I am applying for the membership level of: *

Note: Correspondents and Student Affiliates only need to fill out Section 1 and Section 8.

Section 1 - General Information

Name in Full (no abbreviations) *
Business Name: *
Business Address Line 1:
Business Address Line2:
City:
State:
Zip Code:
E-mail: *
Cell Phone Number:
-
Business Phone Number:
-
Business Website:
Birthdate
Citizenship:

Section 2 - Professional Registration Information

License State
Registration Number
Classification:
How Obtained

Section 3 - Education 

Name and Location of Institution
Years Attended
Date Graduated:
Degree Received:
Field in which Degree was Issued

Section 4 - Qualifications as a Building Inspection Expert

Total years of engineering experience:
Years of building inspection/evaluation experience:
Total number of building inspections/evaluations performed:

Section 5 - Areas of Expertise in the Field of Building Inspection

Areas of Expertise

Section 6 - Special Honors, Awards & Offices Held in Professional Societies

Special Honors:

Criteria for References:

  • Must be Professional Engineers

  • May attest to applicant’s general engineering experience, as well as his/her specific inspection experience

  • May not be business partners or subordinates

    Applicants: List the name and contact information of persons who have personal knowledge of your professional building inspection/evaluation engineering work—particularly those who can substantiate and provide an evaluation of “time in responsible charge of your building inspection and evaluation- related engineering work.” It is recommended that references represent as broad a spectrum of the applicant’s engineering experience as possible. It is the responsibility of each applicant to see that all references are given the included form to complete and that the forms are mailed confidentially to NABIE. 

Reference:(1)
Affiliation:(1)
E-mail (Reference 1): *
Reference Address:(1)
Reference Phone Number:(1)
-
Reference:(2)
Affiliation:(2)
E-mail (Reference 2): *
Reference Address:(2)
Reference Phone Number:(2)
-
Reference:(3)
Affiliation:(3)
E-mail (Reference 3): *
Reference Address:(3)
Reference Phone Number:(3)
-
Reference:(4)
Affiliation:(4)
E-mail (Reference 4): *
Reference Address:(4.)
Reference Phone Number:(4)
-
Reference:(5)
Affiliation:(5)
E-mail (Reference 5):
Reference Address:(5)
Reference Phone Number:(5)
-
Upload files to include with your application like resume, license, proof of ID, etc:
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