IEEE Standards Association (IEEE-SA)
Nominations and Appointments Committee
Form for Membership on IEEE-SA Governance Boards
Name:
Email:
Phone:
Country of residence:
Employer:
Present job title:
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IEEE-SA Governance Board on which membership is desired [Choose one]:
IEEE Standards Association Board of Governors (BOG)
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IEEE Standards Association Standards Board (SASB)*
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*If membership on the SASB is not attained, indicate whether you would be willing to
serve on one of its Standing Committees [Audit Committee (AudCom), New Standards
Committee (NesCom), or Standards Review Committee (RevCom)]:
Yes_________ No__________
IEEE Member:
Yes [Include membership number] _______________
IEEE-SA Member: Yes [Include membership number] _______________
No______
No______
Please list any current or past service on the BOG, SASB, or their committees:
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Member of the following IEEE Societies:
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Participant in the standards development activities of the following IEEE-SA Standards Sponsors:
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Leadership positions held in the Sponsors noted above:
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Copyright ©2012 IEEE
Education (Undergraduate and Graduate levels):
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Participant in the activities of the following non-IEEE standards development organizations:
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Leadership positions held in the non-IEEE standards development organizations noted above:
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Relevant work experience in industry, academia, and government:
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Relevant achievements (e.g., papers/articles published, awards, patents, etc.)
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Candidate statement [optional]:
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Please send completed form to:
David Ringle
Director, IEEE-SA Governance & Technical Committee Programs
d.ringle@ieee.org
Fax: +1 732 875 0524
Copyright ©2012 IEEE