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( Do not publish my contact information in IIE’s Online Member Directory.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