Vacets Membership Form

1. Full Name (Last, First, Middle):

2. Gender (Male/Female): M F

3. Home Address (Optional):
Street
City, State, Zip Code

4. Employer or School Name and Address (including Country):
Name
Street
City, State, Zip Code, Country

5. (Your) Work/Academic Title:

6. Number of Years of Work Experience (or school level if student):

7. Telephone Number:
(W)
(FAX)
(H)(Optional)

8. E-Mail Address:

9. Education Background:

• Field/Major (e.g. EE, ME, AE, CS, Math, etc.):
• Degree(s) (BS, MS/MBA, Ph.D.):

10. Field(s) of Expertise:(e.g. ISDN, Water Eng., Nuclear fusion, HTML, Windows,
ASIC Design, etc.):

11. What are your major areas of interests? (e.g., computer programming, simulation/modeling, electronics design, communications, telecommunications, mechanical design, Mathematics, Physics, biochemistry, etc.):

12. Hobbies (e.g., writing technical papers, sport, music, travel, and community activities, etc.):

13. (Today) Date: