Information for IEEE Members on Joining the Society on Social Implications of Technology

To become a member of SSIT, supply all information requested below, and send with payment to the indicated address.

All affiliates of SSIT receive IEEE Technology and Society Magazine at no extra charge.

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[ ] I am a member of IEEE and want to become a member of SSIT ($24) (include IEEE membership number: ___________).

[ ] I am a student member of IEEE and would like to join SSIT at the $12 student rate (include IEEE membership number: ___________).

Please supply the following information

Name:
Title:
Company or University:
Address:
City:
State:
Zip:
Phone:
Fax:

Signature:
Date:

Enclose payment and send to:
IEEE Service Center
Cash Processing
445 Hoes Lane
Piscataway, NJ 08855