2004 COMMITTEE NOMINATION FORM


Name:.............................................


Signature:........................................


Address:..........................................

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Postcode:........


Tel: (H)..........................................

     (W)..........................................

FAX:    ..........................................


email:  ..........................................


MEMBER GRADE:.....................................

MEMBERSHIP NUMBER:................................


Post return not later than 5 September 2003 to: 

David Burger [Tel: 8266 1371, Fax 8266 3388]
IEEE Committee C/- PROFESSIONAL CENTRE OF AUSTRALIA
Private Bag No. 1
DARLINGHURST NSW 2010.