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Fall 1999 - PES/ICC Meeting Registration

Print, complete and mail this form

IEEE/PES INSULATED CONDUCTORS COMMITTEE

Name:

• Last: ________________________________________________
• First: _____________________________________
• Initial: ______

Badge:

• First name for badge: _____________________
• Guest name badge:
  • First: ____________________
  • Last: __________________________

Address:

• Company: ______________________________________________________________
• Street: _______________________________________________________________
  ______________________________________________________________________
• City: _______________________________
• State/Province: ______________
• Postal Code: __________________
• Country: ________________________

Misc:

• Phone No. _________________________
• Fax No: ___________________________
• E-Mail: _______________________________________

IEEE Member:     Classification [  ] Yes [  ]  No      Member No: ___________________
PES Member:     [  ] Yes [  ] No      Section Name: ______________________________

ICC Member Classification [   ] Guest [  ] Member [  ] Voting Member [  ] Corresponding Member

Note: Procedures for requesting a change in classification are printed in the Minutes or follow the hyperlink above.

Membership in IEC or other Organization: (please specify): __________________________________________