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Student Club Petition: Establishment or Renewal


Use this for to submit your request for establishing or renewing a student club!

 

Required fields are marked with a *.
Is this a renewal?*
Name of EMBS Club*: 
Acadmenic Institution (University)*:
Department*:

Permanent Mailing Address (All monthly mailings will be sent to this school address.)

Street Address*:
City*:
Province/State:
Postal Code/Zip:
Country*:
Attention (if necessary):
Chair Email Address*:
Club Website (if available):


We, the officers of the above named IEEE EMBS Student Club, hereby petition for approval to form an IEEE EMBS Student Club. At least one member of the Student Club, or the advisor, is an IEEE EMBS member.

Title: IEEE Number: Name:
Student Club Chair*:
Student Club Vice-Chair:
Student Club Secretary:
Student Club Treasurer:



Student Club Faculty Advisor:

Faculty Advisor First Name*:
Faculty Advisor Last Name*:
IEEE Member Number*:
Academic Institution (University)*:
Department*:
Box:
Street Address*:
City*:
Province/State:
Postal Code/Zip:
Country*:
Telephone (incl. country code)*:
Fascimile (incl. country code):
Advisor Email*:

 

I understand that the Faculty Advisor must send an email confirming that they are aware of their position to emb-exec@ieee.org in order for my petition to be processed.*
I hereby confirm that prior to submitting this form, myself or the student club chair has already submitted a list of our club membership (including, at a minimum, member names, member email addresses, and date member joined the club) to the EMBS Executive Office in order for this petition to be processed.*

 

 

 

 
 
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