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IEEE Conference Campaign Code Request
Conference Initiator Contact Info
Name
*
Member Number
*
Email
*
Volunteer Position
*
Name of Recipient (if different from above)
Address 1
*
Address 2
City
*
State/Province
*
Postal Code
*
Country
*
Phone Number
*
Council/Section/Society Affiliation
Comments/Special Instructions
Campaign codes will be issued within 2 weeks from the date of submission
Conference Details
Conference Name
*
Conference Location - Venue
*
Conference Location - City
*
Conference Location - State/Province
*
Conference Location - Country
*
Planned Start Date
*
Planned End Date
*
Region
*
----- Select a Region -----
Region 1: Northeastern U.S
Region 2: Eastern U.S.
Region 3: Southeastern U.S.
Region 4: Central U.S.
Region 5: Southwestern U.S.
Region 6: Western U.S.
Region 7: Canada
Region 8: Europe, Middle East and Africa
Region 9: Latin America
Region 10: Asia and Pacific
Expected # of Attendees
*
Conference Contact (Name)
*
Conference Contact (Phone)
*
Conference Contact (Email)
*
Alternate Conference Contact (Name)
Form of payment (if applicable)
*
Campaign Description
*
Example:
Offer a free Society to higher grade members who join at this conference.
Conference Objective
*
Example:
Recruit new members during this particular conference
Conference Summary
*
Example:
Conference name, with dates. Advance registration is now open/closed. Onsite registration form can be filled out and brought to registration onsite. Registration form: http://www.your-conference-reg-form...
Attach PDF of campaign docs:
(i.e., application, marketing communication)
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For questions or comments on this form, please contact
Khanh Luu
.
