IIE MEMBERSHIP APPLICATION



IIE STUDENT MEMBERSHIP APPLICATION

Information (please print clearly):

You can update your member record online at myiie.

( Mr. ( Mrs. ( Ms.

Name:

First Middle Last

Home Address (permanent address):

Address

City___________________________ State/Province________ Zip/Postal Code___________ Country______________________________________________________________________

Phone ( ___ ) _ Cell (optional): ( )

E-mail (required) ____________________________________

School address (optional):

Address

City___________________________ State/Province________ Zip/Postal Code___________ Country______________________________________________________________________

Phone ( ___ ) _ _________________________________________

( Check here to have your name omitted from the mailing lists we share with other organizations.

( Do not publish my contact information in IIE’s Online Member Directory.

Gender: ( Male ( Female

Date of birth (month/day/year) ______

(required for IIE to determine certain awards and recognition)

Membership Dues:

( Student membership fee U.S./ International $32.00

(12 issues of Industrial Engineer magazine are included with membership in U.S.)

International students: add mailed copy for an additional fee of:

( $35 surface mail delivery | ( $86 air mail delivery

Societies:

(in addition to membership fee) For more information go to working.

( Society for Health Systems (SHS): $5

( Society for Engineering & Management Systems (SEMS) $5 (includes a subscription to Industrial Management magazine, a bi-monthly management publication)

Total:

Societies....................................................................... $

Membership Fee....................................................... .. $

Magazines & Journals.................................................. $

Total....................................................... ..................... $

Payment (pre-payment required):

( Check (payable to IIE) Payment of $___________is enclosed. Check #___________

Credit Card: I authorize IIE to charge my credit card: ( MasterCard ( Visa ( AmEx

Credit Card # ____ Expiration date:

Name as it appears on card (print)

Authorized signature: Date

Priority code: STUAP10

Apply online: join

or

return this application to: IIE, 3577 Parkway Lane, Suite 200, Norcross, GA 30092 U.S.A. or fax to (770) 441-3295.

STUDENT SELF-VERIFICATION FORM

This section must be completed in order to process your application.

( I am currently enrolled as a full-time student as defined by my college or university.

( I understand that a fundamental principle of engineering ethics is honesty and that providing false information regarding my student status my result in the revocation of my IIE membership.

University / college attending

Expected date of graduation:

Course of study / expected degree:

Signature:

Date signed:

For questions, please contact IIE Member and Customer Service at (800) 494-4060 or

(770) 449-0460. E-mail: cs@

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