This form is for application for membership or renewal of membership in DASC for 2008. New membership will commence from the date of receipt of this form with payment and end on December 31, 2008. Renewal membership will commence on January 1, 2008 and end on December 31, 2008. The DASC membership fee is $US40.00.
Note that this is separate from membership in the IEEE Standards Association. If you, or the entity with whom you are affiliated, wish to enroll in IEEE-SA to be able to ballot on IEEE standards, you can enroll on the IEEE SA web page.
For DASC membership, please send completed application form and payment to Karen Bartleson, DASC Treasurer, via email, fax, or postal mail at:
Karen Bartleson
Synopsys, Inc.
1125 Point of the
Phone: +1-719-528-5467
Fax: +1-719-533-0209
Email: karenb@synopsys.com
Applications with payment by credit card can be sent by email or fax. Applications with payment by check should be sent by postal airmail. Checks must be drawn on a U.S. bank and made payable to "IEEE Computer Society DASC". If you send your form by mail, please advise Karen by email that you have done so.
Upon receipt of your application, you will receive email acknowledgment and your membership will be recorded. Payment will be forwarded to IEEE for processing.
Name: _______________________________________________________________
Affiliation: _____________________________________________________________
Address: _____________________________________________________________
_____________________________________________________________________
City:
Postal Code: _____________________ Country: ______________________________
Telephone: __________________________ Fax: ______________________________
Email: _______________________________________________________________
IEEE or CS Membership Number: __________________________________________
For Credit Card payment only, please supply the following additional information:
Cardholder's Name: _____________________________________________________
Type of Card: ___________________________ (American Express, Visa, or MasterCard only)
Card Number: _________________________________________________________
Expiration Date (month/year): __________________
Cardholder's Signature: __________________________________________________