2003 Student Membership Application

web application at [Link]/join

1 > PERSONAL INFORMATION Please complete and sign this application, printing clearly. Return to:

Please PRINT your name as you wish it to appear on your membership card and IEEE Admission and Advancement Department
all correspondence. Circle your last/surname as a key identifier for the IEEE database. 445 Hoes Lane, PO Box 1331, Piscataway, NJ USA 08855-1331
Do not exceed 40 characters or spaces per line. USE ONLY English characters Phone: +1 800 678 4333 (US & Canada) or +1 732 981 0060 (Worldwide)
and abbreviate only if more than 40 characters and spaces per line. Fax: +1 732 981 0225 • Email: [Link]@[Link]

Or complete our web application at [Link]/join

FIRST/GIVEN NAME MIDDLE LAST/FAMILY/SURNAME Current IEEE members: Do not use this form to renew your membership; you
Address During Academic Year will receive a renewal invoice.

2 > EDUCATIONAL INFORMATION

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

UNIVERSITY
CITY STATE/PROVINCE
SCHOOL OR COLLEGE (IF APPLICABLE) CAMPUS

P OSTAL C ODE COUNTRY

STREET ADDRESS

PHONE FAX CITY STATE/PROVINCE

COUNTRY POSTAL CODE

EMAIL

Family or Home Address DEGREE TITLE EXPECTED EXPECTED GRADUATION DATE MO/YR

STREET ADDRESS PROGRAM MAJOR/COURSE OF STUDY

Current Degree Program (check one)

UNDERGRADUATE: ❏ 2 OR 3 YEAR ❏ 4 OR 5 YEAR GRADUATE: ❏ MASTERS ❏ PH.D.
CITY STATE/PROVINCE PROGRAM/COURSE OF STUDY: ❏ ELECTRICAL ENG. ❏ COMPUTER ENG. ❏ ELECTRONICS ENG. TECHNOLOGY
❏ COMPUTER SCIENCE ❏ ELECTRONICS ENG. ❏ OTHER (PLEASE DESCRIBE)
P OSTAL C ODE COUNTRY
Do you hold other degrees? ❏ YES (complete below) ❏ NO

PHONE A HIGHEST TECHNICAL DEGREE HELD MO/YR RECEIVED

Date of Birth DAY ____ MONTH _____ YEAR ____ ❏ Male ❏ Female
PROGRAM MAJOR/COURSE OF STUDY AREA OF CONCENTRATION

Please send all IEEE mail to my: ❏ Address During Academic Year
❏ Family or Home Address FULL UNIVERSITY NAME, CAMPUS AND PREVIOUS NAME, IF APPLICABLE
If not indicated, mail will be sent to Address During Academic Year.
CITY/STATE/PROVINCE/COUNTRY

Are you now or were you ever a member of the IEEE? ❏ Yes ❏ No If yes, please provide, if known: B
OTHER DEGREES HELD MO/YR RECEIVED
MEMBERSHIP NUMBER
GRADE YEAR MEMBERSHIP EXPIRED PROGRAM MAJOR/COURSE OF STUDY AREA OF CONCENTRATION

To better serve our members and to supplement member dues, the IEEE mailing list is released to FULL UNIVERSITY NAME, CAMPUS AND PREVIOUS NAME, IF APPLICABLE
other engineering and carefully selected organizations to provide you with information on techni-
cal products and services related to your profession. Please check box if you do not wish to have
your name released to such organizations. ■ CITY/STATE/PROVINCE/COUNTRY

3 > ENDORSEMENT AND SIGNATURE OF APPLICANT

Please print the name and provide the signature and member number of your IEEE Student Branch Counselor. I hereby make application for IEEE membership and agree to be governed by the IEEE
If there is no counselor at your school, please obtain the endorsing signature of a faculty member who is also
an IEEE member (membership number is required). Constitution, Bylaws, and Code of Ethics.
I am taking at least 50% of a full-time academic program.

IEEE BRANCH COUNSELOR’S NAME COUNSELOR’S MEMBER NUMBER

I endorse this application for student membership in the IEEE and certify the degree information as given to be correct and complete.
SIGNATURE DATE
▼

Application must be signed.

IEEE BRANCH COUNSELOR’S SIGNATURE SCHOOL CODE Over Please
 5 > SOCIETY INFORMATION
As an IEEE Student member, you are encouraged to join any Societies in
Who Can Join? your areas of study and technical interest. Each Society membership
IEEE Student membership is open to undergraduate and graduate students who are includes a personal subscription to the core journal, magazine or
enrolled in at least 50% of a normal, full-time course of study in electrical, electronics, newsletter of that Society. Prices are quoted in US dollars.
computer engineering or computer sciences, or in an allied branch of engineering BETWEEN BETWEEN
Please check (✓) appropriate boxes 16 AUG 2002- 1 MAR 2003-
technology or the related arts and sciences. 28 FEB 2003 15 AUG 2003
SOCIETIES PAY PAY
Aerospace and Electronic Systems AES010 12.00 ■ 6.00 ■
Antennas and Propagation AP003 12.00 ■ 6.00 ■
Stay in Contact Broadcast Technology BT002 8.00 ■ 4.00 ■
Your life changes daily, and it is a challenge to stay connected. Get a free IEEE Personal Circuits and Systems CAS004 7.00 ■ 4.00 ■
Email Alias to forward your email wherever you go – you can update your information Communications COM019 13.00 ■ 7.00 ■
online anytime and stay connected no matter where you are. Components, Packaging, CPMT021 6.00 ■ 3.00 ■
[Link]/alias and Manufacturing Technology
Computer CO16 19.00 ■ 10.00 ■
Consumer Electronics CE008 13.00 ■ 7.00 ■
4 > 2003 STUDENT MEMBERSHIP RATES Control Systems CS023 10.00 ■ 5.00 ■
IEEE student dues are based on where you live and when you apply. Please check the appropriate box. Dielectrics and Electrical Insulation DEI032 8.00 ■ 4.00 ■
A subscription to IEEE Potentials magazine is included in US and Canadian membership dues. IEEE Potentials is available Education E025 10.00 ■ 5.00 ■
in other countries for $5 per year. Membership is based on the calendar year from 1 January through 31 December . Electromagnetic Compatibility EMC027 13.00 ■ 7.00 ■
Prices are quoted in US dollars. Electron Devices ED015 3.00 ■ 2.00 ■
Engineering Management EM014 15.00 ■ 8.00 ■
BETWEEN BETWEEN
RESIDENCE 16 AUG 2002 - 28 FEB 2003 1 MAR 2003 - 15 AUG 2003 Engineering in Medicine and Biology EMB018 8.00 ■ 4.00 ■
Dues PAY PAY
Geoscience and Remote Sensing GRS029 14.00 ■ 7.00 ■
United States ...................................................................................$30.00 ■ .......................................$15.00 ■
Industrial Electronics IE013 5.00 ■ 3.00 ■
Canada (includes GST)* ....................................................................$32.00 ■ .......................................$16.00 ■
Industry Applications IA034 3.00 ■ 2.00 ■
Canada (includes HST)* ...................................................................$35.00 ■ .......................................$17.50 ■
Information Theory IT012 15.00 ■ 8.00 ■
Other Countries ...............................................................................$25.00 ■ .......................................$12.50 ■
Instrumentation and Measurement IM009 10.00 ■ 5.00 ■
Options for IEEE members Lasers and Electro-Optics LEO036 9.00 ■ 5.00 ■
Potentials magazine (outside US and Canada) .............................................$5.00 ■ .........................................$3.00 ■ Magnetics MAG033 15.00 ■ 8.00 ■
Proceedings of the IEEE (print ■ or electronic ■ ) ...................................$25.00 ■ ..................................................N/A Microwave Theory and Techniques MTT017 7.00 ■ 4.00 ■
Proceedings of the IEEE (combination) ..................................................$30.00 ■ ..................................................N/A Neural Networks NN011 5.00 ■ 3.00 ■
Standards Association (IEEE-SA).........................................................$10.00 ■ (full year only) Nuclear and Plasma Sciences NPS005 5.00 ■ 3.00 ■
IEEE Women in Engineering (WIE).........................................................FREE ■ (full year only) Oceanic Engineering OE022 10.00 ■ 5.00 ■
*IEEE Canadian Business No. 125634188 Subscriptions to IEEE Spectrum ($16.00/year) and The Institute are included in membership dues. Power Electronics PEL035 6.00 ■ 3.00 ■
A subscription to IEEE Potentials ($5.00/year) is included in US and Canada membership dues.
Power Engineering PE031 11.00 ■ 6.00 ■
Professional Communication PC026 20.00 ■ 10.00 ■
PAYMENT METHOD
Reliability RL007 13.00 ■ 7.00 ■
You may pay for membership by: Robotics and Automation RA024 11.00 ■ 6.00 ■
■ American Express, Visa, MasterCard, Diners Club, Eurocard Signal Processing SP001 12.00 ■ 6.00 ■
■ Check – Payable to the IEEE on a bank in the USA or in acceptable local currency
Social Implications of Technology SIT030 10.00 ■ 5.00 ■
■ Money Orders – Payable on a bank in the USA or in acceptable local currency
Solid-State Circuits SSC037 7.00 ■ 4.00 ■
Systems, Man, and Cybernetics SMC028 5.00 ■ 3.00 ■
6 > PAYMENT AMOUNT Ultrasonics, Ferroelectrics, UFFC020 10.00 ■ 5.00 ■
and Frequency Control
Please total the Membership dues from above
and any Society dues from the side panel.
■ Check ■ i ■[ EUROCARD
■ ■ w Vehicular Technology VT006 8.00 ■ 4.00 ■

IEEE Membership Dues 4 $ ___________ PARTICIPATION IN THE TECHNICAL SOCIETIES OF THE IEEE ADDS VALUE TO YOUR MEMBERSHIP.
CHARGE CARD NUMBER
Potentials (outside US & Canada only)
▼

Proceedings of the IEEE (optional) 4 $ ___________ Student-Get-A-Student Recruiters: For SGS credit
(issued Sept. 2003), please complete below.
Society dues (optional) 5 $ ___________ MONTH YEAR CARDHOLDER’S 5-DIGIT ZIPCODE
EXPIRATION DATE
(BILLING STATEMENT ADDRESS) USA ONLY
IEEE-SA dues (optional) 4 $ ___________
STUDENT MEMBER RECRUITER NAME
Canadian residents pay
7% GST or 15% HST
NAME AS IT APPEARS ON CARD
Reg. no. 125634188 IEEE RECRUITER STUDENT MEMBER # (required for SGS)
on Society payment(s) only TAX $ ________
Amount Paid TOTAL $ _______ SIGNATURE TRACKING CODE PROMO CODE