2016 student membership form
DESCRIPTION
2016 Student Membership FormTRANSCRIPT
STUDENT MEMBERSHIP PACKAGEComputer Society Digital Library (CSDL) included
with your IEEE Computer Society membership.
ELIGIBILITY
Student members must carry at least 50% of a full-time graduate or undergraduate academic program. Current IEEE student members can join Computer Society for US $8.00 and receive access to the Computer Society Digital Library.
Students must apply for membership prior to graduation in 2016.
SCHEDULE OF DUES
Membership is annualized to and expires on 31 December 2016. Pay full or half-year rate depending on the date of receipt by IEEE Computer Society as illustrated below.
Prices expire on 15 August 2016.
MEMBERSHIP OPTIONS
All prices are in U.S. dollars
FULL YEAR Applications received
16 Aug 2015 – 29 Feb 2016
HALF YEAR Applications received
1 Mar 2016 – 15 Aug 2016
Join both IEEE and IEEE Computer Society, plus get access to the CSDL
U.S. AND CANADA $40.00 $20.00
REST OF THE WORLD $35.00 $17.50
I already belong to IEEE and want to join Computer Society, plus get access to the CSDL
$8.00 $4.00
Student members also receive Computer magazine as a Digital Edition (print version is an additional fee).
JOIN IEEE COMPUTER SOCIETY TODAY!
Complete the back of this form, or apply for membership online at www.computer.org/join
When applying online, please be sure to have your educational information and credit card readily available.
Mail or fax your completed form to: IEEE Computer Society
445 Hoes LanePiscataway, NJ 08854-4141 USA
Phone: +1 732-981-0060Fax: +1-732-562-6380
Join online at www.computer.org/join
IEEE Computer Society: Student Membership ApplicationStart your membership immediately: Join online www.computer.org/join
Complete this form, by typing or printing in capital letters. Use only English characters and abbreviate only if using more than 40 character and spaces per line. Incomplete applications cannot be processed.
PERSONAL INFORMATIONPlease PRINT your name, as you want it to appear on your membership card and correspondence. As a key identifier, circle your last/surname.
Male Female Date of Birth (Day/Month/Year) ________________
TITLE FIRST/GIVEN NAME MIDDLE LAST/SURNAME
▼ ADDRESS DURING ACADEMIC YEAR
STREET ADDRESS
CITY STATE/PROVINCE
POSTAL CODE COUNTRY
PHONE FAX EMAIL
▼ FAMILY/HOME ADDRESS
STREET ADDRESS
CITY STATE/PROVINCE
POSTAL CODE COUNTRY
PHONE FAX EMAIL
SEND ALL IEEE MAIL TO: Address During Academic Year
Family/Home Address
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. IEEE does NOT rent out your e-mail address.
Please check this box if you do NOT want to receive these postal mailings.
Are you now or were you ever a member of IEEE? Yes NoIf yes, provide, if known:
MEMBERSHIP NUMBER
WERE YOU REFERRED TO IEEE?
Yes No If yes, provide the following:
MEMBER RECRUITER NAME IEEE RECRUITER’S MEMBER NUMBER (required)
ATTESTATION
I attest that:
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
EDUCATION INFORMATIONPlease complete school/name information. No abbreviations please. This information is required to qualify for student membership.
UNIVERSITY
SCHOOL OR COLLEGE (if applicable) CAMPUS
STREET ADDRESS
CITY STATE/PROVINCE
POSTAL CODE COUNTRY
DEGREE TITLE EXPECTED EXPECTED GRADUATION DATE MO/YR
▼ CURRENT DEGREE PROGRAM (Check one)UNDERGRADUATE: 2 or 3 year 4 or 5 yearGRADUATE: Masters Ph.D.
▼ DO YOU HOLD OTHER DEGREES?
Yes (Complete Below) No
HIGHEST TECHNICAL DEGREE RECEIVED MO/YR RECEIVED
PROGRAM MAJOR/COURSE STUDY AREA OF CONCENTRATION
Which of the following best describes the area of your degree? Please check one:
Engineering
Computer Sciences and Information Technologies
Physical Sciences Biological and Medical Sciences
Mathematics Technical Communications,
Education, Management, Law and Policy Other (please specify):
______________________________________
FULL UNIVERSITY NAME, CAMPUS AND PREVIOUS NAME IF APPLICABLE
CITY STATE/PROVINCE
POSTAL CODE COUNTRY
ADDITIONAL DEGREES HELD MO/YR RECEIVED
PROGRAM MAJOR/COURSE STUDY AREA OF CONCENTRATION
FULL UNIVERSITY NAME, CAMPUS AND PREVIOUS NAME IF APPLICABLE
CITY STATE/PROVINCE
POSTAL CODE COUNTRY
PAYMENT AMOUNT (See other side for dues)
PAYMENT METHODAll 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 $ ___________
AMOUNT PAID ............................................................................. TOTAL $ ___________
Check Visa MasterCard Discover American Express Diners Club
Credit Card Number___________________________________________________________
Expiration Date (Month/Year) ___________ Cardholder’s 5-Digit Zipcode ______________ (Billing Statement Address USA Only)
NAME AS IT APPEARS ON CARD SIGNATURE