ADAN Last Name:ARCE RAMOS

FORMCHECKBOX ApprovedPlease Do NOT Type in This Space

( FOR OFFICE USE ONLY(

Student Dues - $32 per year

Contact Information:

Prefix: FORMCHECKBOX Mr. FORMCHECKBOX Mrs. FORMCHECKBOX Ms. FORMCHECKBOX Dr. FORMCHECKBOX Male FORMCHECKBOX Female

Name:Last:ADANFirst:ARCEMI:RAMOS

School Name:INGENIERIA DE MINAS - UNAMMajor:

Email Address:adan.arce1522@gmail.comBirth Date:11/14/1992

School Mailing Address

Street or PO Box: CALLE AYACUCHI S/N

City:MOQUEGUAState:PERUZip/PC053CountryPERU

Phone:Fax:

Home Mailing Address:

Street or PO Box:

City:State:Zip/PCCountry

Phone:Fax:

Preferred Mailing Address: FORMCHECKBOX Home FORMCHECKBOX School

Student Member Qualifications

A person eligible for election into the class of Student Member must be a full-time college undergraduate or graduate student in good standing. A professional Member who subsequently returns to school for an additional degree cannot become a Student Member. All Student Members must be nominated by an existing Member.

Signature

If elected, I agree to abide by the bylaws and rules of the Society for Mining, Metallurgy, and Exploration, Inc. as the same are now in effect and as they may hereafter be modified while I am a member. I understand that under certain laws and regulations, SME must have my permission in order to communicate with me via fax or email. I hereby give SME Foundation, SME Local Sections and SME business associates permission to send me information and advertisements. If SME does NOT have your permission to communicate with you via fax or email, you many not have access to some of your electronic member benefits.

Signature: (type or sign your name)AdamDate:2015-05-22

Endorsement

Student Member application must be endorsed by an SME Professional or Registered Member.

Name:Member #:

If you currently do not have an endorser, FORMCHECKBOX check this box and we will assign one for you.

SME Membership was recommended to me by:

Continued on next page

Education

Please list school, degree, major, and the date of graduation. Student Members must be full-time students at a school approved by SME

Name of School:Universidad Nacional de Moquegua

Expected Degree:Ciclo : NovenoMajor:

Expected Date of Graduation:2015-12-20

Divisional/Technical Interest

Please indicate, in order of preference (1, 2, 3), a minimum of one and no more than three, technical interest categories.

Divisions:Coal & Energy (F)Technical Interest Committees:1Bulk Material Handling (M)

Environmental (E)2Education (J)

2Industrial Minerals (H)

International Marine Minerals (I)

1Mining & Exploration (Metallics) (A)

3Mineral & Metallurgical Processing (B)

Underground Construction Association (U)

Industry Sector

FORMCHECKBOX Coal Mining (1B) FORMCHECKBOX Geology/Exploration (8) FORMCHECKBOX Metallurgy (9)

FORMCHECKBOX Coal Processing (6) FORMCHECKBOX Government (2) FORMCHECKBOX Metals Mining (1A)

FORMCHECKBOX Economics (4) FORMCHECKBOX Industrial Minerals Mining (1C) FORMCHECKBOX Metals Processing (10)

FORMCHECKBOX Education (3) FORMCHECKBOX Industrial Minerals Processing (1D) FORMCHECKBOX Underground Construction/Tunneling (11)

FORMCHECKBOX Environmental (7) FORMCHECKBOX Manufacturing (5)

Payment

DUES ARE PAYABLE ON A CALENDAR YEAR BASIS. PAYMENT MUST ACCOMPANY APPLICATION.

FORMCHECKBOX Credit Card FORMCHECKBOX Check FORMCHECKBOX Cash FORMCHECKBOX Wire Transfer (contact SME at emas@smenet.org for instructions)

Credit Card Info: FORMCHECKBOX Visa FORMCHECKBOX MasterCard FORMCHECKBOX American Express FORMCHECKBOX Discover

Card Number:Expiry:Sec. Code

Signature (type or sign your name):

Dues:$32

Total$32Please calculate your total here (US Dollars)

UPON COMPLETION OF APPLICATION SEND TO:

Email: emas@smenet.org or

Fax: (303) 948-4265 or

Mail: Society for Mining, Metallurgy, & Exploration

12999 E. Adam Aircraft Circle Englewood, CO 80112 Questions? Please contact Billie Emas at (303) 948-4204 or toll free (800) 763-3132 or emas@smenet.org

THANK YOU!Society for Mining, Metallurgy, and Exploration, Inc. ( 12999 E. Adam Aircraft Circle ( Englewood, CO 80112

Phone: (303) 948-4204 ( Fax: (303) 948-4265 ( e-mail: emas@smenet.org

1