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Name & Contact Information Start your membership immediately: Join online www.ieee.org/join 1 Please complete both side 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. 2008 IEEE STUDENT MEMBERSHIP APPLICATION University School or College (if applicable) Campus Street Address City State/Province Postal Code Country Degree Title Expected Expected Graduation Date Mo/Yr Please complete school/name information. No abbreviations please. This information is required to qualify for Student membership. A. B. Over Please Who Can Join? IEEE Student membership is open to undergraduate and graduate students who are enrolled in at least 50% of a normal, full-time course of study in an IEEE designated field. Are you now or were you ever a member of the IEEE? Yes No If yes, provide, if known: Membership Number Grade Year Expired Please PRINT your name as you want it to appear on your membership card and IEEE correspondence. As a key identifier for the IEEE database, circle your last/surname. Male Female Date of birth (Day/Month/Year) / / I attest that: I am currently a registered undergraduate student at the university level I am currently a registered graduate student and have graduated from a three to five year academic program at the university level My undergraduate program falls within: Engineering Computer Sciences and Information Technologies Physical Sciences Biological and Medical Sciences Mathematics Technical Communications, Education, Management, Law and Policy Other (please specify): _________________ My undergraduate program is accredited in the country where the institution is located. Yes No Do not know I am taking at least 50% of a full-time academic program or course of study in an IEEE designated field of interest. Yes No To better serve our members and supplement member dues, your postal mailing address is made available to carefully selected organizations, to provide you with information on technical services, continuing education, and conferences. Your email address is not rented by IEEE. Please check box only if you do not want to receive these postal mailings. Full University Name, Campus and Previous Name if applicable City State/Province Postal Code Country Other Degrees Held Mo/Yr Received Program Major/Course Study Area of Concentration Full University Name, Campus and Previous Name if applicable City State/Province Postal Code Country Which of the following best describes the area of your degree? Please check one: biological and medical sciences computer sciences and information technology engineering mathematics technical communications, management, education, law & policy physical sciences other Current Degree Program (check one) Undergraduate: 2 or 3 year 4 or 5 year Graduate: Masters Ph.D. Do you hold other degrees? Yes (complete below) No Highest Technical Degree Received Mo/Yr Received Program Major/Course Study Area of Concentration Attestation 2 Education Information 3 Title First/Given Name Middle Last/Family/Surname Address During Academic Year Street Address City State/Province Postal Code Country Phone Fax Email Family or Home Address Street Address City State/Province Postal Code Country Phone Email Send all IEEE mail: Address During Academic Year Family or Home Address

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Page 1: 008 IEEE STUDENT MEMBERSHIP APPLICATION Student Application.pdfIEEE Professional Communication~a` PC026 15.008.00 IEEE Reliability ~` RL007 15.00 8.00 IEEE Robotics and Automationa`

Name & Contact Information

Start your membership immediately: Join online www.ieee.org/join

1

Please complete both side 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.

2008 IEEE STUDENT MEMBERSHIP APPLICATION

University

School or College (if applicable) Campus

Street Address

City State/Province

Postal Code Country

Degree Title Expected Expected Graduation Date Mo/Yr

Please complete school/name information. No abbreviations please. This information is required to qualify for Student membership.

A.

B.

Over Please

Who Can Join?IEEE Student membership is open to undergraduate and graduate

students who are enrolled in at least 50% of a normal, full-time

course of study in an IEEE designated field.

Are you now or were you ever a member of the IEEE? ■■ Yes ■■ No

If yes, provide, if known:

Membership Number Grade Year Expired

Please PRINT your name as you want it to appear on your membership card and IEEE correspondence. As a key identifier for the IEEE database, circle your last/surname.

Male ■■ Female ■■ Date of birth (Day/Month/Year) / /

I attest that:

■■ I am currently a registered undergraduate student at the university level■■ I am currently a registered graduate student and have graduated from a three to five year academic program at the university level

My undergraduate program falls within:■■ Engineering■■ Computer Sciences and Information Technologies■■ Physical Sciences■■ Biological and Medical Sciences■■ Mathematics■■ Technical Communications, Education, Management, Law and Policy■■ Other (please specify): _________________

My undergraduate program is accredited in the country where the institution is located. ■■ Yes ■■ No ■■ Do not know

I am taking at least 50% of a full-time academic program or course of study in an IEEE designated field of interest. ■■ Yes ■■ No

To better serve our members and supplement member dues, your postal mailing address is made available to carefully selected organizations, to provide you with information on technical services, continuing education, and conferences. Your email address is not rented by IEEE.Please check box only if you do not want to receive these postal mailings. ■■

Full University Name, Campus and Previous Name if applicable

City State/Province

Postal Code Country

Other Degrees Held Mo/Yr Received

Program Major/Course Study Area of Concentration

Full University Name, Campus and Previous Name if applicable

City State/Province

Postal Code Country

Which of the following best describes the area of your degree? Please check one: ■■ biological and medical sciences ■■ computer sciences and information technology

■■ engineering ■■ mathematics

■■ technical communications, management, education, law & policy

■■ physical sciences ■■ other

▼ Current Degree Program (check one)

Undergraduate: ■■ 2 or 3 year ■■ 4 or 5 year

Graduate: ■■ Masters ■■ Ph.D.

▼ Do you hold other degrees? ■■ Yes (complete below) ■■ No

Highest Technical Degree Received Mo/Yr Received

Program Major/Course Study Area of Concentration

Attestation2

Education Information3

Title First/Given Name Middle Last/Family/Surname

▼ Address During Academic Year

Street Address

City State/Province

Postal Code Country

Phone Fax Email

▼ Family or Home Address

Street Address

City State/Province

Postal Code Country

Phone Email

Send all IEEE mail: ■■ Address During Academic Year ■■ Family or Home Address

Page 2: 008 IEEE STUDENT MEMBERSHIP APPLICATION Student Application.pdfIEEE Professional Communication~a` PC026 15.008.00 IEEE Reliability ~` RL007 15.00 8.00 IEEE Robotics and Automationa`

Add IEEE Society Memberships (Optional)4 2008 IEEE Student Membership Rates5

Payment Amount7

Were You Referred to IEEE?8

IEEE Student and Graduate student member dues are based on where you live and when you apply. Membership is based on the calendar year from 1 January through 31 December.

Please check ✔ the appropriate box.

RESIDENCE United States .................................................. $30.00 ■■ ........$15.00 ■■Canada (includes GST)* .................................. $31.80 ■■ .........$15.90 ■■Canada (includes HST)* .................................. $34.20 ■■ .........$17.10 ■■Other Countries ............................................... $25.00 ■■ .........$12.50 ■■*IEEE Canada Business No. 125634188

■■ Check ■ ■ i ■ ■ [ ■■ ■■ w

■■ Yes ■■ No If yes, provide the following:

Member Recruiter Name ______________________________________

IEEE Recruiter’s Member Number (Required) _____________________

Name as it appears on card

Signature

IEEE Potentials (outside US/Canada) .................$5.00 ■■ ..........$3.00 ■■IEEE Transactions Nuclear Science (005-106E) .. $00.00 ■■ IEEE Transactions Plasma Science (005-107E) $00.00 ■■ IEEE Transactions Medical Imaging (005-138E) $20.00 ■■ IEEE Sensor Journal (005-186E) $8.00 ■■ .IEEE Women in Engineering (WIE) ....................FREE ■■ .....................n/a

Payment MethodAll 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.

Credit Card Number

CARDHOLDER’S 5-DIGIT ZIPCODE

(BILLING STATEMENT ADDRESS) USA ONLY

MONTH YEAREXPIRATION DATE

Please total the IEEE Student Membership dues, Society dues and other amounts from this page:

IEEE Student Membership dues ................................ $ ______IEEE Potentials (outside US & Canada only) ............... $ ______IEEE NPS005 Society dues Tracking Code 134167.. $ 0.00__IEEE Transactions selection (Web only) $ ______IEEE-SA dues (optional) ............................................ $ ______Canadian residents pay 6% GST or 14% HST Regno.125634188 on Society payments & publications only ................. TAX $ ______

AMOUNT PAID ......................................................... TOTAL $ ______

5

6

4

6

6

A print subscription to IEEE Potentials is included in US & Canada mem-bership dues, outside the US & Canada it is available for US$5 per year.

Please check ✔ the appropriate box. BETWEEN16 AUG 2006-28 FEB 2007

PAY

BETWEEN1 MAR 2007-15 AUG 2007

PAY

BETWEEN16 AUG 2006-28 FEB 2007

PAY

BETWEEN1 MAR 2007-15 AUG 2007

PAY

PROMO CODETRACKING CODE

IEEE Aerospace and Electronic Systems AES010 13.00 ■■ 7.00 ■■

IEEE Antennas and Propagation AP003 12.00 ■■ 6.00 ■■

IEEE Broadcast Technology BT002 8.00 ■■ 4.00 ■■

IEEE Circuits and Systems CAS004 9.00 ■■ 5.00 ■■

IEEE Communications C0M019 21.00 ■■ 11.00 ■■

IEEE Components, Packaging, & Manu. Tech. CPMT021 6.00 ■■ 3.00 ■■

IEEE Computational Intelligence CIS011 10.00 ■■ 5.00 ■■

IEEE Computer C016 24.00 ■■ 12.00 ■■

IEEE Consumer Electronics CE008 8.00 ■■ 4.00 ■■

IEEE Control Systems CS023 13.00 ■■ 7.00 ■■

IEEE Dielectrics and Electrical Insulation DEI032 10.00 ■■ 5.00 ■■

IEEE Education E025 10.00 ■■ 5.00 ■■

IEEE Electromagnetic Compatibility EMC027 13.00 ■■ 7.00 ■■

IEEE Electron Devices ED015 6.00 ■■ 3.00 ■■

IEEE Engineering in Medicine and Biology EMB018 18.00 ■■ 9.00 ■■

IEEE Engineering Management EM014 15.00 ■■ 8.00 ■■

IEEE Geoscience and Remote Sensing GRS029 11.00 ■■ 6.00 ■■

IEEE Industrial Electronics IE013 8.00 ■■ 4.00 ■■

IEEE Industry Applications IA034 10.00 ■■ 5.00 ■■

IEEE Information Theory IT012 15.00 ■■ 8.00 ■■

IEEE Instrumentation and Measurement IM009 10.00 ■■ 5.00 ■■

IEEE Intelligent Transportation Systems ITS038 13.00 ■■ 7.00 ■■

IEEE Lasers and Electro-Optics LE0O36 13.00 ■■ 7.00 ■■

IEEE Magnetics MAG033 10.00 ■■ 5.00 ■■

IEEE Microwave Theory and Techniques MTT017 7.00 ■■ 4.00 ■■

IEEE Nuclear and Plasma Sciences NPS005 15.00 ■■ 7.00 ■■

IEEE Oceanic Engineering OE022 10.00 ■■ 5.00 ■■

IEEE Power Electronics PEL035 10.00 ■■ 5.00 ■■

IEEE Power Engineering PE031 15.00 ■■ 8.00 ■■

IEEE Product Safety Engineering PSE043 18.00 ■■ 9.00 ■■

IEEE Professional Communication PC026 15.00 ■■ 8.00 ■■

IEEE Reliability RL007 15.00 ■■ 8.00 ■■

IEEE Robotics and Automation RA024 11.00 ■■ 6.00 ■■

IEEE Signal Processing SP001 14.00 ■■ 7.00 ■■

IEEE Social Implications of Technology SIT030 13.00 ■■ 7.00 ■■

IEEE Solid-State Circuits SSC037 10.00 ■■ 5.00 ■■

IEEE Systems, Man, & Cybernetics SMC028 6.00 ■■ 3.00 ■■

IEEE Ultrasonics, Ferroelectrics, & Frequency Control UFFC020 10.00 ■■ 5.00 ■■

IEEE Vehicular Technology VT006 9.00 ■■ 5.00 ■■

The optional 39 IEEE Societies support your technical and professional interests. Many society memberships include a personal subscription to the core journal, magazine or newsletter of that society. For a complete list of everything included with your IEEE Society membershipvisit www.ieee.org/join.

Please check ✔ the appropriate box.

Please reprint your full name here

BETWEEN1 MAR 2007-15 AUG 2007

PAY

BETWEEN 16 AUG 2006-28 FEB 2007

PAY

Complete both sides of this form, sign and return to:IEEE Application Processing445 Hoes Lane, PO Box 6801, Piscataway, NJ 08855-6801 USAor fax to +1 732 981 0225or join online at www.ieee.org/join

One or more Society publication(s) Society newsletter

Legend – Society membership includes:

Online access to publication(s) CD-ROM

More Recommended Options6