2010 IEEE Membership Application

(students and graduate students should apply online)

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

Title/Position Years in Position Years in Profession 1. General and corporate management
2. Engineering management
3. Project engineering management
Street Address City State/Province 4. Research and development
management
5. Design engineering management
Postal Code Country - analog
6. Design engineering management
- digital
7. Research and development
Office Phone Office Fax Office E-mail
engineering
8. Design/development engineering
- analog
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
▼
9. Design/development
engineering - digital
10. Hardware engineering
11. Software design/development
12. Computer science
13. Science/physics/mathematics
14. Engineering (not elsewhere
specified)
15. Marketing/sales/purchasing
16. Consulting
17. Education/teaching
18. Retired
19. Other______________________

▼
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

I have ______ years of professional experience in teaching, creating, developing,

practicing, or managing within the following field: 4 Please Sign Your Application
■ Engineering I hereby apply for IEEE membership and agree to be governed by the
■ Computer Sciences and Information Technologies IEEE Constitution, Bylaws and Code of Ethics. I understand that IEEE
■ Physical Sciences will communicate with me regarding my individual membership and all
■ Biological and Medical Sciences related benefits. Application must be signed.
■ Mathematics
■ Technical Communications, Education, Management, Law and Policy
■ Other (please specify): _________________
Signature Date
Over Please

09-MEMB-0202-Member-Application-2010-Pad-Final.indd 1 8/13/09 9:02:07 AM

 5 Add IEEE Society Memberships (Optional) 6 2010 IEEE Membership Rates
(student rates available online)
The 38 IEEE Societies support your technical and professional interests.
Many society memberships include a personal subscription to the core IEEE member dues and regional assessments are based on where
journal, magazine or newsletter of that society. For a complete list of you live and when you apply. Membership is based on the calendar
everything included with your IEEE Society membership year from 1 January through 31 December.
visit www.ieee.org/join. BETWEEN BETWEEN
Please check ✔ the appropriate box. 16 AUG 2009- 1 MAR 2010-
Please check ✔ the appropriate box. BETWEEN BETWEEN 28 FEB 2010 15 AUG 2010
16 AUG 2009- 1 MAR 2010- PAY PAY
28 FEB 2010 15 AUG 2010 RESIDENCE
PAY PAY United States............................................... $175.00 ■ . .........$87.50 ■
IEEE Aerospace and Electronic Systems z y AES010 25.00 ■ 12.50 ■ Canada (includes GST)*............................... $159.70 ■. ..........$79.85 ■
IEEE Antennas and Propagation z y AP003 24.00 ■ 12.00 ■ Canada (includes HST)*............................... $170.42 ■. ..........$85.21 ■
IEEE Broadcast Technology § z y BT002 15.00 ■ 7.50 ■ Africa, Europe, Middle East.......................... $147.00 ■. ..........$73.50 ■
IEEE Circuits and Systems z y § CAS004 18.00 ■ 9.00 ■ Latin America............................................... $138.00 ■. ..........$69.00 ■
IEEE Communications z y C0M019 25.00 ■ 12.50 ■
Asia, Pacific.................................................. $139.00 ■. ..........$69.50 ■
*IEEE Canada Business No. 125634188
IEEE Components, Packaging, & Manu. Tech. § CPMT021 10.00 ■ 5.00 ■
IEEE Computational Intelligence z y CIS011 22.00 ■ 11.00 ■ Minimum Income or Unemployed Provision
Applicants who certify that their prior year income did not exceed US$12,900
IEEE Computer z y C016 50.00 ■ 25.00 ■ (or equivalent) or were not employed are granted 50% reduction in: full year dues,
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IEEE Education § z y E025 20.00 ■ 10.00 ■ 7 More Recommended Options

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IEEE Electron Devices § z y ED015 12.00 ■ 6.00 ■ Proceedings of the IEEE............. print $35.00 ■ or online $33.00 ■
Proceedings of the IEEE (print/online combination) . ............$46.00 ■
IEEE Engineering in Medicine and Biology z y EMB018 35.00 ■ 17.50 ■
IEEE Standards Association (IEEE-SA).................................$45.00 ■
IEEE Geoscience and Remote Sensing § y GRS029 16.00 ■ 8.00 ■
IEEE Women in Engineering (WIE)........................................$25.00 ■
IEEE Industrial Electronics z y IE013 15.00 ■ 7.50 ■
IEEE Industry Applications z y IA034 20.00 ■ 10.00 ■
IEEE Information Theory § z y IT012 30.00 ■ 15.00 ■ 8 Payment Amount
IEEE Instrumentation and Measurement z y IM009 28.00 ■ 14.00 ■ Please total the Membership dues, Society dues and other amounts
IEEE Intelligent Transportation Systems § z y ITSS O38 35.00 ■ 17.50 ■ from this page:
IEEE Magnetics § y tz MAG033 25.00 ■ 12.50 ■
IEEE Membership dues 6 .............................................. $_ ______
IEEE Microwave Theory and Techniques z y MTT017 17.00 ■ 8.50 ■
IEEE Society dues (optional) 5 ...................................... $_ ______
IEEE Nuclear and Plasma Sciences § y NPS005 35.00 ■ 17.50 ■
IEEE-SA/WIE dues (optional) 7 ...................................... $_ ______
IEEE Oceanic Engineering § z y OE022 19.00 ■ 9.50 ■
Proceedings of the IEEE (optional) 7 .............................. $_ ______
IEEE Photonics § y PHO036 30.00 ■ 15.00 ■ Canadian residents pay 5% GST or 13% HST Reg
no. 125634188 on Society payments & publications only................. TAX $_ ______
IEEE Power Electronics § y PEL035 20.00 ■ 10.00 ■
Amount paid.......................................................... TOTAL $_ ______
IEEE Power & Energy z y PE031 35.00 ■ 17.50 ■
IEEE Product Safety Engineering § PSE043 35.00 ■ 17.50 ■ Payment Method
IEEE Professional Communication § z y PC026 30.00 ■ 15.00 ■ All prices are quoted in US dollars. You may pay for IEEE membership
IEEE Reliability § z y RL007 35.00 ■ 17.50 ■ by credit card (see below), check or money order payable to IEEE,
drawn on a US bank.
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IEEE Signal Processing § z y SP001 29.00 ■ 14.50 ■ ■ Check ■ i ■ [ ■ ■ w
IEEE Social Implications of Technology § z y SIT030 28.00 ■ 14.00 ■
IEEE Solid-State Circuits z y SSC037 26.00 ■ 13.00 ■
IEEE Systems, Man, & Cybernetics § y z SMC028 12.00 ■ 6.00 ■ Credit Card Number

IEEE Ultrasonics, Ferroelectrics, & Frequency Control §zy UFFC020 20.00 ■ 10.00 ■
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MONTH YEAR cardholder’s 5-digit zipcode
EXPIRATION DATE (Billing statement address) USA ONLY

Legend – Society membership includes:

z One or more Society publication(s)
§ Society newsletter
Complete both sides of this form, sign and return to:
IEEE Membership Application Processing
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y Online access to publication(s)
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t  Name as it appears on card
publications
Signature
9 Were You Referred to IEEE?
■ Yes ■ No If yes, provide the following:
Member Recruiter Name___________________________________
09-MEMB-0202 8/09

IEEE Recruiter’s Member Number (Required)_ _____________________

CAMPAIGN CODE PROMO CODE

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09-MEMB-0202-Member-Application-2010-Pad-Final.indd 2 8/13/09 9:02:07 AM