PES-ICC Membership Application Form

Rachel I. Mosier, P.E.
Power Delivery Consultants
162 Bushy Hill Road
Deep River, CT 06417
e-mail: rachel.mosier@ieee.org

Dear Ms. Mosier:

I presently belong to the IEEE Power Engineering Society and wish to become a Member of the Insulated Conductors Committee (ICC). I am aware of the Membership requirements. I would like to become active in the Working Groups or Discussion Groups that I have listed in the table below.

Name: _____________________________________________________________

Please Type or Print

Company

Address: _____________________________________________________________

_____________________________________________________________

_____________________________________________________________

Telephone: __________________________ Fax #: ________________________

E-mail: ____________________________________________

IEEE #: __________________________ Region #: _____________________

Section Name (and Location): ______________________________________________

Signature: _____________________________________________________________

I would like to actively participate in the Working/Discussion Groups listed below.
(Follow the hyperlinks for a list of groups under each Subcommittee.)

Print, complete and mail the form to the address at the top.

This page last revised on 06/02/08