Membership Application

The Textile, Fiber & Film Committee welcomes your interest in becoming a member! There is no application fee involved, however, committee members must already be members of the IEEE and the Industry Applications Society of the IEEE. Please contact Ken Fussell at (704) 558-4196 or kenneth_fussell@parsons.com if you have questions.

Please print this form, complete it and then mail it to:	Ken Fussell
	Parsons, Inc.
	4701 Hedgemore Drive
	Charlotte, NC 28209

or fax to Ken at (704) 529-0374.

Please provide the following information:

Name

Title

Organization

Street address

Address (cont.)

City

State/Province

Zip/Postal code

Country

Work Phone

Home Phone

FAX

E-mail

URL

Are you a member of the IEEE?:

Membership Number

Are you a member of the IAS?
Yes
No

Please describe what kind of work you do:
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________

Last revised: June 11, 1998

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Name
Title
Organization
Street address
Address (cont.)
City
State/Province
Zip/Postal code
Country
Work Phone
Home Phone
FAX
E-mail
URL