Anniversary Certificate Order Form

Anniversary Certificate Request Form
The purpose of the Anniversary Membership Certificate is to mark a member’s milestone anniversary years

Requirements for this award is that the member must have achieved either 25, 50 or 75 years of membership.

Recipients receive a printed certificates acknowledging the member’s specific 25th, 50th or 75th anniversary of their initiation and the chapter.

The cost is $4.00 each plus shipping.

No nominations are required for this award.

Certificates are available upon the member achieving their respective anniversary date. They are traditionally presented at Founders Day events or at other appropriate times by a Chapter Collegiate or alumni association. However, any member may request an anniversary certificate.

Please Note: Anniversary Certificate Requests must be submitted no later than ten days in advanced to allow for processing.

If you have any questions about the anniversary certificate program, please email Phil Aiello at paiello@sae.net.

Tell us about the certificate
Certificate Type *
Certificate Presentation Date *

Month Day Year
Date
Presented on behalf of a(n).. *
Staff Pin *
Tell us about the member
Member Name *
As you wish it to appear on the certificate
Initiated Chapter *
Initiation Date *

Month Day Year
Date

Today's Date

Month Day Year
Date
Date Calculation
Initiation Date Calculation
Month Full
Day Full
Year Full
Tell us about yourself
Name of Nominator *
First and Last
Nominator Email Address *
Nominator Phone Number *

Anniversary Certificate Mockup

Please review all details before proceeding.
Anniversary Certificates will print with information as it appears below.
If you would like to make any edits, visit the previous page and change any spelling mistakes.

Approve Certificate Mockup *

I approve of the Anniversary Certificate as displayed above, and approve to print the information as previewed.

Shipping and Purchase Details
Shipping Method *
Order Number *
Included in e-mail receipt
Would you like to add on a Certificate Holder? *
Available upon request

Shipping Address for Certificate *

Street Address
Street Address Line 2
City	State / Province
Postal / Zip Code	Country

Payment Details *

USD

Credit Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Certificate Cost
Shipping Fee
Certificate Holder Cost
Total
Order Number UID
Order Number Mask
Should be Empty:

Anniversary Certificate Request Form

Anniversary Certificate Mockup

Shipping and Purchase Details