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2007 ieee international symposium on electromagnetic compatibility

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68EMC <str<strong>on</strong>g>2007</str<strong>on</strong>g> ADVANCE PROGRAM Yes! I want to join:<str<strong>on</strong>g>2007</str<strong>on</strong>g> IEEE Electromagnetic Compatibility SocietyProfessi<strong>on</strong>al Membership/Subscripti<strong>on</strong> Applicati<strong>on</strong>Membership subscripti<strong>on</strong>s are annualized to, and expire <strong>on</strong>, 31 December <str<strong>on</strong>g>2007</str<strong>on</strong>g>.Pay full or half-year rate depending up<strong>on</strong> the date of receipt by the IEEEIEEE benefits include a m<strong>on</strong>thly subscripti<strong>on</strong> to IEEE Spectrum magazineIEEE EMC-S benefits include a quarterly subscripti<strong>on</strong> to the EMC-S Newsletter and the IEEETransacti<strong>on</strong>s <strong>on</strong> Electromagnetic CompatibilityMembership Opti<strong>on</strong>s:All prices quoted in U.S. dollars FULL YEAR HALF YEARApplicati<strong>on</strong>s received Applicati<strong>on</strong>s received16 Aug 06 – 28 Feb 07 1 Mar 07 – 15 Aug 07I do not bel<strong>on</strong>g to the IEEE. I want to join <strong>on</strong>ly the EMCS. $ 87.00 ❑ $44.00 ❑Professi<strong>on</strong>al Affiliati<strong>on</strong>(s): ____________________________I reside in the United States $189.00 ❑ $94.50 ❑I reside in Canada (Including HST) $187.72 ❑ $94.43 ❑I reside in Canada (Including GST) $175.88 ❑ $88.47 ❑I reside in Africa/Europe/Middle East $159.00 ❑ $80.00 ❑I reside in Latin America $152.00 ❑ $76.50 ❑I reside in Asia/Pacific $153.00 ❑ $77.00 ❑I reside in Asia/Pacific (Tokyo Council) $178.00 ❑ $89.50 ❑I already bel<strong>on</strong>g to the IEEE and I now want to join the EMCS. $ 25.00 ❑ $13.00 ❑I am a student (select the category that applies):I Reside in USA and wish to join the IEEE and the EMCS $ 43.00 ❑ $22.00 ❑I reside in Canada (HST ) and wish to join the IEEE and the EMCS $ 49.02 ❑ $25.08 ❑I reside in Canada (GST ) and wish to join the IEEE and the EMCS $ 45.48 ❑ $23.32 ❑I reside outside USA/Canada) and wish to join the IEEE & the EMCS $ 38.00 ❑ $19.50 ❑I am a Student IEEE member and wish to join the EMCS $ 13.00 ❑ $ 7.00 ❑(IEEE members <strong>on</strong>ly need to furnish name, address, and IEEE number with payment.) Canadian residents pay 6% GST or 14% HST Reg. No. 125634188 <strong>on</strong> Society payment(s) and Publicati<strong>on</strong>s <strong>on</strong>lyMinimum Income or Unemployed Provisi<strong>on</strong>Applicants who certify that their prior year income did not exceed US$11,900 (or equivalent) or were notemployed are granted 50%reducti<strong>on</strong> in full year dues, regi<strong>on</strong>al assessment and fees for <strong>on</strong>e IEEE Society. Ifapplicable, please check appropriate box and adjust payment accordingly. Student members are not eligible.I certify I earned less than US$11,900 in 2005 ❑I certify that I was unemployed in 2005❑Are you now or were you ever a member of the IEEE?Yes ❑ No ❑ If yes, provide IEEE number if known: _________________Pers<strong>on</strong>al Informati<strong>on</strong>:Please enter your name as you want it to appear <strong>on</strong> corresp<strong>on</strong>dence.Gender (opti<strong>on</strong>al): Male ❑ Female ❑ Date of birth (Opti<strong>on</strong>al): (DD/MM/YYYY) ___/___/_______________________________________________________________________________________________Title First name Middle Last/Surname___________________________________________________________________________________________Home address___________________________________________________________________________________________CityState/Province___________________________________________________________________________________________Postal CodeCountry___________________________________________________________________________________________Home teleph<strong>on</strong>eFacsimile___________________________________________________________________________________________Preferred e-mailBusiness/Professi<strong>on</strong>al Informati<strong>on</strong>:___________________________________________________________________________________________Title/Positi<strong>on</strong>___________________________________________________________________________________________Years in current positi<strong>on</strong>Years of practice since graduati<strong>on</strong>___________________________________________________________________________________________Employer nameDepartment/Divisi<strong>on</strong>___________________________________________________________________________________________Street address City State/Province___________________________________________________________________________________________Postal CodeCountry___________________________________________________________________________________________Office teleph<strong>on</strong>eOffice facsimileSEND MAIL TO: ❑ Home Address OR ❑ Business/School AddressPayment Informati<strong>on</strong>Payment is required with applicati<strong>on</strong>IEEE membership feeAMOUNT PAIDEnclosed:❑ Check/M<strong>on</strong>ey Order †Charge my:❑ MasterCard❑ Visa❑ American Express❑ Diner’s Club$____TAX $____TOTAL $_________________________________________________Card Number_____________________________________________Expirati<strong>on</strong> Date (m<strong>on</strong>th/year)_____________________________________________SignatureUSA-<strong>on</strong>ly include 5-digit billing zip code□□□□□† Payable to the IEEE in U.S. dollars drawn <strong>on</strong> a U.S.bank account. Please include member name andnumber (if known) <strong>on</strong> your check.In order for us to process yourapplicati<strong>on</strong>, you must complete andreturn this form to:IEEE Admissi<strong>on</strong> and Advancement445 Hoes LanePO Box 6804Piscataway, NJ 08855-6802 USAor Fax to (732) 981-0225 (credit cardpayments <strong>on</strong>ly)(Allow up to 8 weeks to completeapplicati<strong>on</strong> processing)I hereby make applicati<strong>on</strong> forElectromagnetic CompatibilitySociety and/or IEEE membershipand agree to be governed byIEEE’s C<strong>on</strong>stituti<strong>on</strong>, Bylaws,Statements of Policies andProcedures, and Code of Ethics.I authorize release of informati<strong>on</strong>related to this applicati<strong>on</strong> todetermine my qualificati<strong>on</strong>s formembership.___________________________SignatureDateAPPLICATION MUST BE SIGNED©<str<strong>on</strong>g>2007</str<strong>on</strong>g> IEEE www.emc<str<strong>on</strong>g>2007</str<strong>on</strong>g>.org

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