Вы находитесь на странице: 1из 2

SPECIAL MEMBERSHIP PACKAGE FOR STUDENTS IN 2012!

receive membership in both IEEE and IEEE Computer Society, plus get FREE access to the Computer Society Digital Library (CSDL)*
ELIGIBILITY _________________________________________________________
To become a student member, you must carry at least 50% of a full-time graduate or undergraduate academic program. If you are currently an IEEE student member, you can join the Computer Society for one low fee and receive access to the Computer Society Digital Library. (U.S. and Canada members, add US$8.00 to IEEE membership. All others, add US$13.00.) You must apply for membership prior to graduation in 2012.

FOR JUST $40,

SCHEDULE OF DUES __________________________________________________


Membership is annualized to and expires on 31 December 2012. Pay full or half-year rate depending on the date of receipt by the Computer Society as illustrated below. Prices expire on 15 August 2012.

MEMBERSHIP OPTIONS
All prices are in U.S. dollars

FULL YEAR

HALF YEAR

Applications received Applications received 16 Aug 2011 28 Feb 2012 1 Mar 2012 15 Aug 2012 $40.00 $20.00

Join both IEEE and the IEEE Computer Society, plus get access to the CSDL I already belong to IEEE and want to join the Computer Society, plus get access to the CSDL U.S. AND CANADA REST OF THE WORLD

$8.00 $13.00

$4.00 $7.00

*Student members also receive Computer magazine as a Digital Edition (print version is not included).

JOIN IEEE COMPUTER SOCIETY TODAY!


Complete the back of this form, or apply for membership online at www.computer.org/membership When applying online, please be sure to have the following available: your educational information and a valid credit card. Mail or fax your completed form to:
IEEE Computer Society 10662 Los Vaqueros Circle Los Alamitos, CA 90720-1314 Phone: +1-800-272-6657 or +1-714-821-8380 FAX: +1-714-821-4641 E-mail: help@computer.org IEEE Computer Society KFK Building 2-14-14 Minami-Aoyama Minato-ku, Tokyo 107-0062, Japan Phone: +81-3-3408-3118 FAX: +81-3-3408-3553 E-mail: tokyo.ofc@computer.org

or join online at www.computer.org/membership

2012 IEEE COMPUTER SOCIETY STUDENT MEMBERSHIP APPLICATION


Start your membership immediately: Join online www.computer.org/membership
Complete this form, by typing or printing in capital letters. Use only English characters and abbreviate only if using more than 40 characters and spaces per line. Incomplete applications cannot be processed.

Name & Contact Information


Please PRINT your name as you want it to appear on your membership card and correspondence. As a key identifier, circle your last/surname.
Male Title Female First/Given Name Date of birth (Day/Month/Year) Middle

Education Information
Please complete school/name information. No abbreviations please. This information is required to qualify for Student membership.
University School or College (if applicable) Street Address City State/Province Country Fax E-mail Postal Code Degree Title Expected State/Province Country Expected Graduation Date Mo/Yr Campus

Last/Family/Surname

Address During Academic Year

Street Address City Postal Code Phone

Current Degree Program (check one)


2 or 3 year 4 or 5 year

Undergraduate:

Graduate:

Masters No

Ph.D.

Family or Home Address

Do you hold other degrees?

Yes (complete below)

Street Address City Postal Code Phone


Send all IEEE mail:

A.
Highest Technical Degree Received State/Province Country E-mail
Address During Academic Year Family or Home Address

Mo/Yr Received Area of Concentration

Program Major/Course Study

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
Full University Name, Campus and Previous Name if applicable City Postal Code State/Province Country

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.

Are you now or were you ever a member of the IEEE? If yes, provide, if known: Membership Number Grade

Yes

No

B.
Year Expired Other Degrees Held Program Major/Course Study Area of Concentration Mo/Yr Received

Were You Referred to IEEE?


Yes No If yes, provide the following: Member Recruiter Name ____________________________________________ IEEE Recruiters Member Number (Required) ___________________________

Full University Name, Campus and Previous Name if applicable City Postal Code State/Province Country

Attestation
I attest that:

Payment Amount please see other side for dues


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 U.S. bank.
Canadian residents pay 5% GST or 13% HST ............................ TAX $ _________

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

AMOUNT PAID ................................................................... TOTAL $ _________ Check

Credit Card Number

MONTH YEAR EXPIRATION DATE

CARDHOLDERS 5-DIGIT ZIPCODE (BILLING STATEMENT ADDRESS) USA ONLY

Name as it appears on card Signature

Вам также может понравиться