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2011 IEEE MEMbErshIp ApplIcAtIon
(students and graduate students must 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 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 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
5 Add IEEE Society Memberships (Optional) 6 2011 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 2010- 1 MAR 2011-
28 FEB 2011 15 AUG 2011
Please check ✔ the appropriate box. BETWEEN BETWEEN PAY PAY
16 AUG 2010- 1 MAR 2011- RESIDENCE
28 FEB 2011 15 AUG 2011
PAY PAY United States .............................................. $178.00 ■ ..........$89.00 ■
Canada (includes GST)* .............................. $161.80 ■ ...........$80.90 ■
IEEE Aerospace and Electronic Systems z y AES010 25.00 ■ 12.50 ■
Canada (includes NB, NF and ON HST)* .... $172.68 ■ ...........$86.34 ■
IEEE Antennas and Propagation z y AP003 24.00 ■ 12.00 ■
Canada (includes Nova Scotia HST)* .......... $175.40 ■ ...........$87.70 ■
IEEE Broadcast Technology § z y BT002 15.00 ■ 7.50 ■
Canada (includes BC HST)* ........................ $171.32 ■ ...........$85.66 ■
IEEE Circuits and Systems z y § CAS004 18.00 ■ 9.00 ■
Africa, Europe, Middle East ......................... $149.00 ■ ...........$74.50 ■
IEEE Communications z y C0M019 25.00 ■ 12.50 ■ Latin America .............................................. $140.00 ■ ...........$70.00 ■
IEEE Components, Packaging, & Manu. Tech. § CPMT021 10.00 ■ 5.00 ■ Asia, Pacific................................................. $141.00 ■ ...........$70.50 ■
IEEE Computational Intelligence z y CIS011 22.00 ■ 11.00 ■ *IEEE Canada Business No. 125634188
IEEE Computer z y C016 52.00 ■ 26.00 ■ Minimum Income or Unemployed Provision
Applicants who certify that their prior year income did not exceed US$13,600
IEEE Consumer Electronics § y CE008 15.00 ■ 7.50 ■ (or equivalent) or were not employed are granted 50% reduction in: full year dues,
IEEE Control Systems z y CS023 20.00 ■ 10.00 ■ regional assessment and fees for one IEEE Membership plus one Society
Membership. If applicable, please check appropriate box and adjust payment
IEEE Dielectrics and Electrical Insulation z y DEI032 25.00 ■ 12.50 ■ accordingly. Student members are not eligible.
IEEE Education § z y E025 20.00 ■ 10.00 ■ ■ I certify I earned less than US$13,600 in 2009 or 2010
IEEE Electromagnetic Compatibility § y EMC027 30.00 ■ 15.00 ■ ■ I certify that I was unemployed in 2009 or 2010
IEEE Electron Devices § z y ED015 12.00 ■ 6.00 ■ 7 More Recommended Options
IEEE Engineering in Medicine and Biology z y EMB018 35.00 ■ 17.50 ■
Proceedings of the IEEE ............ print $36.00 ■ or online $34.00 ■
IEEE Geoscience and Remote Sensing § y GRS029 18.00 ■ 9.00 ■
Proceedings of the IEEE (print/online combination) .............$47.00 ■
IEEE Industrial Electronics z y IE013 15.00 ■ 7.50 ■
IEEE Standards Association (IEEE-SA).................................$47.00 ■
IEEE Industry Applications z y IA034 20.00 ■ 10.00 ■
IEEE Women in Engineering (WIE) .......................................$25.00 ■
IEEE Information Theory § z y IT012 30.00 ■ 15.00 ■
IEEE Instrumentation and Measurement z y IM009 28.00 ■ 14.00 ■ 8 Payment Amount
IEEE Intelligent Transportation Systems § z y ITSS O38 35.00 ■ 17.50 ■
Please total the Membership dues, Society dues and other amounts
IEEE Magnetics § y tz MAG033 25.00 ■ 12.50 ■
from this page:
IEEE Microwave Theory and Techniques z y MTT017 17.00 ■ 8.50 ■
IEEE Membership dues 6 ............................................. $ ______
IEEE Nuclear and Plasma Sciences § y NPS005 35.00 ■ 17.50 ■
IEEE Society dues (optional) 5 ..................................... $ ______
IEEE Oceanic Engineering § z y OE022 19.00 ■ 9.50 ■ IEEE-SA/WIE dues (optional) 7 ..................................... $ ______
IEEE Photonics § y PHO036 30.00 ■ 15.00 ■ Proceedings of the IEEE (optional) 7 ............................. $ ______
IEEE Power Electronics § y PEL035 20.00 ■ 10.00 ■ Canadian residents pay 5% HST or appropriate HTS (BC12%, NB, NF,
ON-13%,NS-15%) on Society payments & publications only ............ TAX $ ______
IEEE Power & Energy z y PE031 35.00 ■ 17.50 ■
AmounT PAId ......................................................... ToTAL $ ______
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,
IEEE Robotics and Automation z y RA024 9.00 ■ 4.50 ■ drawn on a US bank.
IEEE Signal Processing § z y
IEEE Social Implications of Technology § z y
SP001
SIT030
29.00 ■
29.00 ■
14.50 ■
14.50 ■
■ Check ■ i ■ [ ■ ■ w
IEEE Solid-State Circuits z y SSC037 28.00 ■ 14.00 ■
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 ■
IEEE Vehicular Technology z y VT006 18.00 ■ 9.00 ■
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) y Online access to publication(s)
t CD-ROM of selected society Name as it appears on card
§ Society newsletter
publications
Signature
Complete both sides of this form, sign and return to:
IEEE Membership Application processing 9 Were You Referred to IEEE?
445 hoEs ln, pIscAtAWAY nJ 08854-4141 UsA
■ Yes ■ No If yes, provide the following:
or fax to +1 732 981 0225
Member Recruiter Name __________________________________
or join online at www.ieee.org/join
10-MEMB-0242 8/10
IEEE Recruiter’s Member Number (Required) _____________________
CAMPAIGN CODE PROMO CODE
Please reprint your full name here
