2012 IEEE MEMbErshIp ApplIcAtIon

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1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. Computers Computer peripheral equipment Software Office and business machines Test, measurement and instrumentation equipment Communications systems and equipment Navigation and guidance systems and equipment Consumer electronics/appliances Industrial equipment, controls and systems ICs and microprocessors Semiconductors, components, sub-assemblies, materials and supplies Aircraft, missiles, space and ground support equipment Oceanography and support equipment Medical electronic equipment OEM incorporating electronics in their end product (not elsewhere classified) Independent and university research, test and design laboratories and consultants (not connected with a mfg. co.) Government agencies and armed forces Companies using and/or incorporating any electronic products in their manufacturing, processing, research or development activities Telecommunications services, telephone (including) cellular Broadcast services (TV, cable, radio) Transportation services (airline, railroad, etc.) Computer and communications and data processing services Power production, generation, transmission and distribution Other commercial users of electrical, electronic equipment and services (not elsewhere classified) Distributor (reseller, wholesaler, retailer) University, college/other educational institutions, libraries Retired Other__________________________

Name & Contact Information 1 PERSONAL INFORMATION

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2
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Attestation
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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:

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Please Sign Your Application

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

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

AES010 AP003 BT002 CAS004

C0M019

25.00 24.00 15.00 18.00 25.00 10.00 26.00 53.00 15.00 20.00 25.00 20.00 30.00 15.00 40.00 18.00 15.00 20.00 30.00 28.00 35.00 25.00 17.00 35.00 19.00 30.00 20.00 35.00 35.00 30.00 35.00 9.00 20.00 30.00 28.00 12.00 20.00 18.00

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

CPMT021 CIS011 C016 CE008 CS023 DEI032 E025 EMC027 ED015 GRS029 IE013 IA034 IT012 IM009 ITSS O38 MAG033 MTT017 NPS005 OE022 PHO036 PEL035 PE031 PSE043 PC026 RL007 RA024 SP001 SIT030 SSC037 SMC028 VT006

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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.

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IEEE Engineering in Medicine and Biology z y EMB018

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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 ............................. $ ______
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IEEE Ultrasonics, Ferroelectrics, & Frequency Control zy UFFC020

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11-MEMB-0228 8/11

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