Give the
GIFT of IEEE
Present a world of opportunity
• Career Resources • Collaboration
• Global Network
When you give the gift of an IEEE Student Membership, you’re helping someone you
care about build a platform for success. That’s because IEEE delivers access to the industry’s
most essential technical information, provides both local and global networking opportunities,
offers career development tools, local humanitarian opportunities as well as many other
exclusive member benefits.
Whether your student is in an undergraduate or graduate degree program,
IEEE offers unparalleled experiences both on campus and off. Most universities have
an active IEEE student member community that sponsors events, competitions, and
more. After graduation, IEEE offers the career tools and resources today’s
students need to get a jumpstart on their careers.
To help your student achieve his/her goals, simply fill out this form.
Your gift recipient will receive an email notification with instructions on
how to get started. Please allow 7–10 business days from receipt of this
application for your recipient to receive an e-mail notification to set up
their account. Questions? E-mail mga-email@ieee.org.
Give the
GIFT of IEEE
3
Educational Information of Recipient
Please complete school/name information. No abbreviations please.
This information is required to qualify for student membership.
▼
• Career Resources
• Collaboration
• Global Network
Current Degree Program (check one)
Undergraduate: ■ 2- or 3-year
■ 4- or 5-year
Graduate:
■ Ph.D.
■ Masters
University
School or College (if applicable)
Campus
2017 IEEE Student Membership Application
Degree Title Expected
Expected Graduation Date Mo/Yr
Who Can Join?
Which of the following best describes the area of their degree? Please check one:
■ Biological and Medical Sciences
■ Computer Sciences and Information Technology
■ Engineering
■ Mathematics
■ Technical Communications, Management, Education, Law and Policy
■ Physical Sciences
■ Other
Please complete all information. We regret that incomplete applications
cannot be processed.
IEEE Student Membership is open to undergraduate and graduate students who are
enrolled in at least 50% of a normal, full-time course of study in an IEEE designated field.
Other Degrees (check one)
Undergraduate: ■ 2- or 3-year ■ 4- or 5-year
▼
1
Title
Your Information
Graduate:
First/Given Name
Middle Name
Last/Family Surname
Phone
■ Masters
■ Ph.D.
Which of the following best describes the area of their other degree? Please check one:
■ Biological and Medical Sciences
■ Computer Sciences and Information Technology
■ Engineering
■ Mathematics
■ Technical Communications, Management, Education, Law and Policy
■ Physical Sciences
■ Other
E-mail (required for processing of receipt)
Full University Name, Campus and Previous Name if applicable
Are you a member of IEEE?
■ Yes ■ No
If yes, provide, if known:
CityState/Province
Membership Number
Grade
Country
2
■ Male
Title
■ Female
Date of Birth (Day/Month/Year)
First/Given Name
Primary Address
The undergraduate program is accredited in the country where the institution is located.
■ Yes
■ No ■ Do not know
Middle Name
■ Home
/
/
Recipient is taking at least 50% of a full-time academic program or course of study in an
IEEE designated field of interest.
■ Yes ■ No
Last/Family Surname
4
■ School (All IEEE mail sent here)
2017 IEEE Student Membership Rates
Street Address
IEEE member dues are based on where your gift recipient lives. Membership is
based on the calendar year from 1 January through 31 December. All prices are
quoted in US dollars.
CityState/Province
Please check ✔ the appropriate box.
Postal Code Country
Primary Phone
Primary E-mail
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Secondary Address
■ Home
RECIPIENT RESIDENCE
United States..................................................................................................................................................... $32.00 ■
Canada (GST)*................................................................................................................................................. $33.60 ■
Canada (GST and QST Quebec).............................................................................................................. $36.79 ■.
Canada (NB, NF, NS, and PEI HST)*...................................................................................................... $36.80 ■
Canada (ON HST)*........................................................................................................................................ $36.16 ■
Other Countries................................................................................................................................................$27.00 ■.
*IEEE Canada Business No. 125634188
■ School
Company Name
Department/Division
Street Address
City
Postal Code
Country
Secondary Phone
Secondary E-mail
State/Province
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 US bank.
■ Check
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■
■
Credit Card Number
Complete this form and return to:
IEEE MEMBERSHIP APPLICATION PROCESSING
445 HOES LN, PISCATAWAY, NJ 08854-4141 USA
or fax to +1 732 981 0225
Please allow 7–10 business days from receipt of this application for
your recipient to receive an e-mail notification to set up their account.
MONTH
YEAR
EXPIRATION DATE
CARDHOLDER’S 5-DIGIT ZIP CODE
(BILLING STATEMENT ADDRESS) USA ONLY
Name as it appears on card
Signature
PROMO CODE
MEMGIFT
16-MEM-108 S 7/16
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Gift Recipient Information