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Credit Card Form (For Membership Fee)

If you have any questions, please ask member@ieice.org

Apply for Membership Qualification

Classification *


Note
OMDP is for candidates from countries/areas in Asia (except Republic of Korea, Taiwan, China and Singapore), Africa, Central America and South America, etc.

Personal Information

Full Name

First Name *
Middle Name
Last Name *

Nationality *

Sex *

  

Title *

        

Date of Birth *

Day / Month / Year    e.g. 24/12/1970

E-mail

Main *
e.g. sample@example.com
Main (For a check) *
e.g. sample@example.com
Sub
e.g. sample@example.com
Sub (For a check)
e.g. sample@example.com

Mailing Address

Preferred Mailing Address *

  

Home

Address *
Country *
Phone Number *
Fax Number

Office

Name *
Note Name of School / Company
Address *
Country *
Phone Number *
Fax Number

Academic Background

For Member

The highest academic degree *            
Name of
University / College / School*
Note Name of University / College / School of the highest academic degree
Date of graduation * Month / Year    e.g. 08/2000

For Student Member

Name of
University / College / School*
Note Name of University / College / School you belong to
Academic degree *            
Expected date of graduation * Month / Year    e.g. 08/2015

Application Information

Period *

Society registration (Membership dues includes one Society of Transaction of Online version) *

Additional Societies (Optional)

Remittance (Remittance is available only in Japanese yen by a credit card)

IEEE Membership Number *

(8 digits)

IEEE Membership Expiration Date *

Day / Month / Year    e.g. 31/12/2016

IEEE Membership Card Upload *

If you upload a copy of IEEE membership card (PDF within 1MB), the admission charge is free.

Note Any other file except PDF are not acceptable.
Note Use only English for the file/directory name.

Membership Dues for IEEE Member

Admission charge ¥ (Japanese Yen) Not a number
Membership dues * ¥ (Japanese Yen) Not a number
Additional Societies (Optional) ¥ (Japanese Yen) Not a number

Total ¥ (Japanese Yen)    

Credit Card *

           

Credit Card Number *

(15 or 16 digits)

Credit Card Expiration Date *

Month / Year    e.g. 12/2016

Full Name of the Credit Card Holder *

Endorsement

IEICE requests you to nominate an endorser.
If you have an endorser, please fill out the IEICE membership number and the name.

Endorser's Number
Note Endorser's IEICE Membership Number
Endorser's Name
Note Endorser's Name

If you don't have an endorser, please fill out the reason for application.

Reason for application