Student Chapter Promotion Materials Request Form
Use this form to request the materials you need to promote IIE Membership. Shipping
and handling fees are applicable. Send completed form to Membership Coordinator at
chapters@iienet.org or fax it to 770-263-8532.
Please indicate how many of each of the following you would like to receive.
Item
Membership Materials
Quantity
20
40
60
Graduate



Undergraduate



Scholarships, Awards & Competitions Postcard



Student Mentoring Flyer



Society for Engineering Management Systems
brochures (SEMS)



Society for Health Systems brochures (SHS)



Student Advisor Flyer:



Other
Student Membership Brochure & Application
Student Posters - for recruiting and publicizing events and
Mush Pit
Rock Climber
meetings. Circle which one you want and indicate quantity.
Publications
Quantities limited. Available while supplies last
5
10
15
Industrial Engineer Magazine:



Blue
Green
Pink
Other
IIE Logo Items
IIE Sharpie Retractable Highlighter - $1:25 each or
$1:00 each for 25 or more. Indicate color & quantity.
Yellow
IIE Ballpoint Pen - $1:25 each or $1:00 each for 25 or
more. Indicate quantity.
IIE Horizontal Monitor Calendar
$1:25 each or $1:00 each for 25 or more.
Updated 7-29-08
Is there anything else that would be helpful? We'll let you know if your request is possible.
Shipping & Handling Information
**REQUIRED**
Shipping Address
Name: ________________________________________________________________
Address 1: ____________________________________________________________
Address 2: ____________________________________________________________
City, State, Zip: ________________________________________________________
E-mail: _______________________________________________________________
Telephone: ____________________________________________________________
Billing Information (shipping fees only)
 Send me an invoice
 Payment information is provided below
Credit Card (MC, VISA, AMEX): __________________________
Name on Card: __________________________________________
Card Number: ___________________________________________
Expiration: _____________________________________________
Updated 7-29-08