2012 IEEE Membership Application

(students and graduate students must apply online)

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

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.

Please Tell Us About Yourself

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.
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__________________________

INFORMATION Name & Contact Information 1 PERSONAL

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)

Title

First/Given Name

Middle

Last/Family Surname

Primary Address

Home Business (All IEEE mail sent here)

Street Address City State/Province Postal Code Country

Primary Phone Primary E-mail

Secondary Address Home Business

Department/Division

Company Name Title/Position Street Address Postal Code

B. Principal job function

1. 2. 3. 4. 5. 6. 7. 8. General and corporate management Engineering management Project engineering management Research and development management Design engineering management - analog Design engineering management - digital Research and development engineering Design/development engineering - analog

City Country

State/Province

Secondary Phone Secondary E-mail

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 e-mail address is not rented by IEEE. Please check box only if you do not want to receive these postal mailings to the selected address.

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______________________

C. Principal responsibility
1. 2. 3. 4. 5. Engineering and scientific management Management other than engineering Engineering design Engineering Software: science/mngmnt/engineering 6. 7. 8. 9.

Education/teaching Consulting Retired Other _______________________

2
Yes

Attestation
No

I have graduated from a three-to-five-year academic program with a university-level degree. This program is in one of the following fields of study:

D. Title
1. 2. 3. 4. 5. 6. 7. 8. 9. Chairman of the Board/President/CEO Owner/Partner General Manager VP Operations VP Engineering/Dir. Engineering Chief Engineer/Chief Scientist Engineering Management Scientific Management Member of Technical Staff

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 No Do not know is located. Yes I have ______ years of professional experience in teaching, creating, developing, practicing, or managing within the following field:

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 _______________________

Are you now or were you ever a member of IEEE? Yes No If yes, provide, if known: Membership Number Grade Year Expired

Please Sign Your Application

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

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

Over Please

A. Primary line of business

Add IEEE Society Memberships (Optional)

2012 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 journal, magazine or newsletter of that society. For a complete list of everything included with your IEEE Society membership, visit www.ieee.org/join. All prices are quoted in US dollars. Please check the appropriate box.
IEEE Aerospace and Electronic Systems z y IEEE Antennas and Propagation z y IEEE Broadcast Technology z y IEEE Circuits and Systems z y IEEE Communications z y

IEEE member dues and regional assessments are based on where you live and when you apply. Membership is based on the calendar year from 1 January through 31 December. All prices are quoted in US dollars. Please check the appropriate box.
BETWEEN 16 AUG 201128 FEB 2012 PAY BETWEEN 1 MAR 201215 AUG 2012 PAY

BETWEEN BETWEEN 16 AUG 2011- 1 MAR 201228 FEB 2012 15 AUG 2012 PAY PAY

AES010 25.00 AP003 24.00 BT002 15.00 CAS004 18.00

C0M019

12.50 12.00 7.50 9.00 12.50 5.00 13.00 26.50 7.50 10.00 12.50 10.00 15.00 7.50 20.00 9.00 7.50 10.00 15.00 14.00 17.50 12.50 8.50 17.50 9.50 15.00 10.00 17.50 17.50 15.00 17.50 4.50 10.00 15.00 14.00 6.00 10.00 9.00

25.00 10.00

IEEE Components, Packaging, & Manu. Tech. IEEE Computational Intelligence z y IEEE Computer z y IEEE Consumer Electronics y IEEE Control Systems z y IEEE Dielectrics and Electrical Insulation z y IEEE Education z y IEEE Electromagnetic Compatibility y IEEE Electron Devices z y IEEE Engineering in Medicine and Biology z y IEEE Geoscience and Remote Sensing y IEEE Industrial Electronics z y IEEE Industry Applications z y IEEE Information Theory z y IEEE Instrumentation and Measurement z y IEEE Intelligent Transportation Systems z y IEEE Magnetics y tz IEEE Microwave Theory and Techniques z y IEEE Nuclear and Plasma Sciences y IEEE Oceanic Engineering z y IEEE Photonics y IEEE Power Electronics y IEEE Power & Energy z y IEEE Product Safety Engineering IEEE Professional Communication z y IEEE Reliability z y IEEE Robotics and Automation z y IEEE Signal Processing z y IEEE Social Implications of Technology z y IEEE Solid-State Circuits z y IEEE Systems, Man, & Cybernetics y z IEEE Vehicular Technology z y

CPMT021

CIS011 26.00 C016 53.00 CE008 CS023 15.00 20.00

RESIDENCE United States............................................... $183.00 ...........$91.50 Canada (includes GST)*............................... $163.90 ............$81.95 Canada (includes NB, NF and ON HST)*..... $174.94 ............$87.47 Canada (includes Nova Scotia HST)*........... $177.70 ............$88.85 Canada (includes BC HST)*......................... $173.56 ............$86.78 Africa, Europe, Middle East.......................... $151.00 ............$75.50 Latin America............................................... $142.00 ............$71.00 Asia, Pacific.................................................. $143.00 ............$71.50
*IEEE Canada Business No. 125634188

Minimum Income or Unemployed Provision

DEI032 25.00 E025 20.00 EMC027 30.00 ED015 15.00

Applicants who certify that their prior year income did not exceed US$13,800 (or equivalent) or were not employed are granted 50% reduction in: full year dues, regional assessment and fees for one IEEE Membership plus one Society Membership. If applicable, please check appropriate box and adjust payment accordingly. Student members are not eligible.

I certify I earned less than US$13,800 in 2010 or 2011 I certify that I was unemployed in 2010 or 2011

EMB018 40.00
GRS029 18.00 IE013 15.00 IA034 20.00 IT012 30.00 IM009 28.00 ITSS O38 35.00 MAG033 25.00 MTT017 17.00 NPS005 35.00 OE022 19.00 PHO036 30.00 PEL035 20.00 PE031 35.00 PSE043 35.00 PC026 30.00 RL007 35.00 RA024 9.00 SP001 20.00 SIT030 30.00 SSC037 28.00 SMC028 12.00 VT006 18.00

More Recommended Options

Proceedings of the IEEE............. print $39.00 or online $35.00 Proceedings of the IEEE (print/online combination) ..............$49.00 IEEE Standards Association (IEEE-SA).................................$49.00 IEEE Women in Engineering (WIE)........................................$25.00

Payment Amount

Please total the Membership dues, Society dues and other amounts from this page: IEEE Membership dues 6 .............................................. $_______ IEEE Society dues (optional) 5 ...................................... $_______ IEEE-SA/WIE dues (optional) 7 ...................................... $_______ Proceedings of the IEEE (optional) 7 .............................. $_______
Canadian residents pay 5% GST or appropriate HST (BC12%; NB, NF, ON-13%;NS-15%) on Society payments & publications only............. TAX

$_______

Amount paid.......................................................... 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. Check

IEEE Ultrasonics, Ferroelectrics, & Frequency Control zy UFFC020 20.00

Credit Card Number

LegendSociety membership includes: y Online access to publication(s) z One or more Society publication(s) t  CD-ROM of selected society Society newsletter publications

MONTH YEAR EXPIRATION DATE

cardholders 5-digit zipcode (Billing statement address) USA ONLY

Name as it appears on card Signature

IEEE Recruiters Member Number (Required)______________________

CAMPAIGN CODE PROMO CODE

Please reprint your full name here

11-MEMB-0228 8/11

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

Were You Referred to IEEE?

Yes No If yes, provide the following: Member Recruiter Name___________________________________