IEEE MEMBERSHIP FORM

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PERSONAL INFORMATION
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1 Name & Contact Information
I have graduated from a three-to-five-year academic program with a university-level degree.
■ Yes ■ No
This program is in one of the following fields of study:
■ Engineering
■ Computer Sciences and Information Technologies
■ Physical Sciences
■ Biological and Medical Sciences
■ Mathematics
■ Technical Communications, Education, Management, Law and Policy
■ Other (please specify): _________________
This academic institution or program is accredited in the country where the institution
is located. ■ Yes ■ No ■ Do not know
I have ______ years of professional experience in teaching, creating, developing,
practicing, or managing within the following field:
■ Engineering
■ Computer Sciences and Information Technologies
■ Physical Sciences
■ Biological and Medical Sciences
■ Mathematics
■ Technical Communications, Education, Management, Law and Policy
■ Other (please specify): _________________
2 Attestation
I hereby apply for IEEE membership and agree to be governed by the
IEEE Constitution, Bylaws and Code of Ethics. I understand that IEEE
will communicate with me regarding my individual membership and all
related benefits. Application must be signed.
Signature Date
4 Please Sign Your Application
3 Please Tell Us About Yourself
Male ■ Female ■ Date of birth (Day/Month/Year) / /
Send all IEEE mail: ■ Home Address ■ Business Address
Please complete both sides of this form, typing or printing in capital letters.
Use only English characters and abbreviate only if more than 40 characters and
spaces per line. We regret that incomplete applications cannot be processed.
(students and graduate students should apply online)
A. Primary line of business
1. Computers
2. Computer peripheral equipment
3. Software
4. Office and business machines
5. Test, measurement and instrumentation equipment
6. Communications systems and equipment
7. Navigation and guidance systems and equipment
8. Consumer electronics/appliances
9. Industrial equipment, controls and systems
10. ICs and microprocessors
11. Semiconductors, components, sub-assemblies, materials and supplies
12. Aircraft, missiles, space and ground support equipment
13. Oceanography and support equipment
14. Medical electronic equipment
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.)
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
20. Broadcast services (TV, cable, radio)
21. Transportation services (airline, railroad, etc.)
22. Computer and communications and data processing services
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)
26. University, college/other educational institutions, libraries
27. Retired
28. Other__________________________
Over Please
▼
B. Principal job function
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______________________
1. General and corporate management
2. Engineering management
3. Project engineering management
4. Research and development
management
5. Design engineering management
- analog
6. Design engineering management
- digital
7. Research and development
engineering
8. Design/development engineering
- analog
▼
D. Title
1. Chairman of the Board/President/CEO
2. Owner/Partner
3. General Manager
4. VP Operations
5. VP Engineering/Dir. Engineering
6. Chief Engineer/Chief Scientist
7. Engineering Management
8. Scientific Management
9. Member of Technical Staff
10. Design Engineering Manager
11. Design Engineer
12. Hardware Engineer
13. Software Engineer
14. Computer Scientist
15. Dean/Professor/Instructor
16. Consultant
17. Retired
18. Other _______________________
▼
C. Principal responsibility
▼
1. Engineering and scientific management
2. Management other than engineering
3. Engineering design
4. Engineering
5. Software: science/mngmnt/engineering
6. Education/teaching
7. Consulting
8. Retired
9. Other _______________________
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Membership Number Grade Year Expired
Select the numbered option that best describes yourself. This
information is used by IEEE magazines to verify their annual circulation.
Please enter numbered selections in the boxes provided.
2010 IEEE Mem bership Application
Title First/Given Name Middle Last/Family Surname
▼ Home Address
Street Address
City State/Province
Postal Code Country
Home Phone Home E-mail
▼ Business Address
Company Name Department/Division
Title/Position Years in Position Years in Profession
Street Address City State/Province
Postal Code Country
Office Phone Office Fax Office E-mail
09-MEMB-0202-Member-Application-2010-Pad-Final.indd 1 8/13/09 9:02:07 AM
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RESIDENCE
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■ I certify I earned less than US$13,400 in 2008 or 2009
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IEEE Aerospace and Electronic Systems z y AES010 25.00 ■ 12.50 ■
IEEE Antennas and Propagation z y AP003 24.00 ■ 12.00 ■
IEEE Broadcast Technology § z y BT002 15.00 ■ 7.50 ■
IEEE Circuits and Systems z y § CAS004 18.00 ■ 9.00 ■
IEEE Communications z y C0M019 25.00 ■ 12.50 ■
IEEE Components, Packaging, & Manu. Tech. § CPMT021 10.00 ■ 5.00 ■
IEEE Computational Intelligence z y CIS011 22.00 ■ 11.00 ■
IEEE Computer z y C016 50.00 ■ 25.00 ■
IEEE Consumer Electronics § y CE008 15.00 ■ 7.50 ■
IEEE Control Systems z y CS023 20.00 ■ 10.00 ■
IEEE Dielectrics and Electrical Insulation z y DEI032 20.00 ■ 10.00 ■
IEEE Education § z y E025 20.00 ■ 10.00 ■
IEEE Electromagnetic Compatibility § y EMC027 30.00 ■ 15.00 ■
IEEE Electron Devices § z y ED015 12.00 ■ 6.00 ■
IEEE Engineering in Medicine and Biology z y EMB018 35.00 ■ 17.50 ■
IEEE Geoscience and Remote Sensing § y GRS029 16.00 ■ 8.00 ■
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 ■
IEEE Instrumentation and Measurement z y IM009 28.00 ■ 14.00 ■
IEEE Intelligent Transportation Systems § z y ITSS O38 35.00 ■ 17.50 ■
IEEE Magnetics § y tz MAG033 25.00 ■ 12.50 ■
IEEE Microwave Theory and Techniques z y MTT017 17.00 ■ 8.50 ■
IEEE Nuclear and Plasma Sciences § y NPS005 35.00 ■ 17.50 ■
IEEE Oceanic Engineering § z y OE022 19.00 ■ 9.50 ■
IEEE Photonics § y PHO036 30.00 ■ 15.00 ■
IEEE Power Electronics § y PEL035 20.00 ■ 10.00 ■
IEEE Power & Energy z y PE031 35.00 ■ 17.50 ■
IEEE Product Safety Engineering § PSE043 35.00 ■ 17.50 ■
IEEE Professional Communication § z y PC026 30.00 ■ 15.00 ■
IEEE Reliability § z y RL007 35.00 ■ 17.50 ■
IEEE Robotics and Automation z y RA024 21.00 ■ 10.50 ■
IEEE Signal Processing § z y SP001 29.00 ■ 14.50 ■
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 ■
IEEE Ultrasonics, Ferroelectrics, & Frequency Control § zy UFFC020 20.00 ■ 10.00 ■
IEEE Vehicular Technology z y VT006 18.00 ■ 9.00 ■
The 38 IEEE Societies support your technical and professional interests.
Many society memberships include a personal subscription to the core
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visit www.ieee.org/join.
Please check ✔ the appropriate box.
CAMPAIGN CODE PROMO CODE
BETWEEN
16 AUG 2009-
28 FEB 2010
PAY
BETWEEN
1 MAR 2010-
15 AUG 2010
PAY
■ Yes ■ No If yes, provide the following:
Member Recruiter Name___________________________________
IEEE Recruiter’s Member Number (Required)_ _____________________
Credit Card Number
Name as it appears on card
Signature
Proceedings of the IEEE............. print $35.00 ■ or online $33.00 ■
Proceedings of the IEEE (print/online combination) ..............$46.00 ■
IEEE Standards Association (IEEE-SA).................................$45.00 ■
IEEE Women in Engineering (WIE)........................................$25.00 ■
Please total the Membership dues, Society dues and other amounts
from this page:
IEEE Membership dues .............................................. $_ ______
IEEE Society dues (optional) ...................................... $_ ______
IEEE-SA/WIE dues (optional) ...................................... $_ ______
Proceedings of the IEEE (optional) .............................. $_ ______
Canadian residents pay 5% GST or 13% HST Reg
no. 125634188 on Society payments & publications only................. TAX $_ ______
Amount pai d.......................................................... TOTAL $_ ______
Payment Method
All prices are quoted in US dollars. You may pay for IEEE membership
by credit card (see below), check or money order payable to IEEE,
drawn on a US bank.
6
cardholder’s 5-digit zipcode
(Biling statement adres) USA ONLY
MONTH YEAR
EXPIRATION DATE
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Please reprint your full name here
BETWEEN
1 MAR 2010-
15 AUG 2010
PAY
BETWEEN
16 AUG 2009-
28 FEB 2010
PAY
Complete both sides of this form, sign and return to:
IEEE Membership Application Processing
445 HOES LN, PISCATAWAY NJ 08854-4141 USA
or fax to +1 732 981 0225
or join online at www.ieee.org/join
z One or more Society publication(s)
§ Society newsletter
Legend – Society membership includes:
y Online access to publication(s)
t CD-ROM of selected society
publications
5 Add IEEE Society Memberships (Optional) 2010 IEEE Membership Rates
(student rates available online)
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7 More Recommended Options
8 Payment Amount
9 Were You Referred to IEEE?
09-MEMB-0202 8/09
09-MEMB-0202-Member-Application-2010-Pad-Final.indd 2 8/13/09 9:02:07 AM