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Ieee Application
Ieee Application
Start your membership immediately: Join online www.ieee.org/join 3 Please Tell Us About Yourself
Please complete both sides of this form, typing or printing in capital letters. Select the numbered option that best describes yourself. This
Use only English characters and abbreviate only if more than 40 characters and information is used by IEEE magazines to verify their annual circu-
spaces per line. We regret that incomplete applications cannot be processed. lation. Please enter numbered selections in the boxes provided.
A. Primary line of business
▼
1 PERSONAL INFORMATION
Name & Contact Information 1. Computers
2. Computer peripheral equipment
Please PRINT your name as you want it to appear on your membership card and IEEE 3. Software
correspondence. As a key identifier for the IEEE database, circle your last/surname. 4. Office and business machines
5. Test, measurement and instrumentation equipment
Male ■ Female ■ Date of birth (Day/Month/Year) 6. Communications systems and equipment
/ / 7. Navigation and guidance systems and equipment
8. Consumer electronics/appliances
9. Industrial equipment, controls and systems
Title First/Given Name Middle Last/Family Surname 10. ICs and microprocessors
11. Semiconductors, components, sub-assemblies, materials and supplies
▼ Home Address 12. Aircraft, missiles, space and ground support equipment
13. Oceanography and support equipment
14. Medical electronic equipment
Street Address 15. OEM incorporating electronics in their end product (not elsewhere classified)
16. Independent and university research, test and design laboratories and
consultants (not connected with a mfg. co.)
City State/Province 17. Government agencies and armed forces
18. Companies using and/or incorporating any electronic products in their
manufacturing, processing, research or development activities
19. Telecommunications services, telephone (including) cellular
Postal Code Country 20. Broadcast services (TV, cable, radio)
21. Transportation services (airline, railroad, etc.)
22. Computer and communications and data processing services
Home Phone Home E-mail 23. Power production, generation, transmission and distribution
24. Other commercial users of electrical, electronic equipment and services
(not elsewhere classified)
25. Distributor (reseller, wholesaler, retailer)
▼ Business Address 26. University, college/other educational institutions, libraries
27. Retired
28. Other__________________________
Company Name Department/Division
B. Principal job function
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Title/Position Years in Position Years in Profession 1. General and corporate management 9. Design/development
2. Engineering management engineering - digital
3. Project engineering management 10. Hardware engineering
Street Address City State/Province 4. Research and development 11. Software design/development
management 12. Computer science
5. Design engineering management 13. Science/physics/mathematics
Postal Code Country - analog 14. Engineering (not elsewhere
6. Design engineering management specified)
- digital 15. Marketing/sales/purchasing
7. Research and development 16. Consulting
Office Phone Office Fax Office E-mail
engineering 17. Education/teaching
8. Design/development engineering 18. Retired
- analog 19. Other______________________
Send all IEEE mail: ■ Home Address ■ Business Address
To better serve our members and supplement member dues, your postal mailing address is made available to C. Principal responsibility
▼
carefully selected organizations, to provide you with information on technical services, continuing education, and
conferences. Your e-mail address is not rented by IEEE. Please check box only if you do not want to receive these 1. Engineering and scientific management 6. Education/teaching
postal mailings to the selected address. ■ 2. Management other than engineering 7. Consulting
3. Engineering design 8. Retired
4. Engineering 9. Other _______________________
5. Software: science/mngmnt/engineering
2 Attestation
D. Title
▼
I have graduated from a three-to-five-year academic program with a university-level degree.
■ Yes ■ No 1. Chairman of the Board/President/CEO 10. Design Engineering Manager
2. Owner/Partner 11. Design Engineer
This program is in one of the following fields of study: 3. General Manager 12. Hardware Engineer
4. VP Operations 13. Software Engineer
■ Engineering
5. VP Engineering/Dir. Engineering 14. Computer Scientist
■ Computer Sciences and Information Technologies 6. Chief Engineer/Chief Scientist 15. Dean/Professor/Instructor
■ Physical Sciences 7. Engineering Management 16. Consultant
■ Biological and Medical Sciences 8. Scientific Management 17. Retired
■ Mathematics 9. Member of Technical Staff 18. Other _______________________
■ Technical Communications, Education, Management, Law and Policy
■ Other (please specify): _________________ Are you now or were you ever a member of the IEEE?
■ Yes ■ No If yes, provide, if known:
This academic institution or program is accredited in the country where the institution
is located. ■ Yes ■ No ■ Do not know Membership Number Grade Year Expired
IEEE Ultrasonics, Ferroelectrics, & Frequency Control §zy UFFC020 20.00 ■ 10.00 ■
IEEE Vehicular Technology z y VT006 18.00 ■ 9.00 ■
MONTH YEAR cardholder’s 5-digit zipcode
EXPIRATION DATE (Billing statement address) USA ONLY