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| First Name* |
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Middle Name |
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Last Name* |
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| Telephone Number |
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Fax Number |
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| Email Address* |
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IEEE Member ID# |
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Note:
The total US$ is the net amount to be received by the deadline of October 15, 2018.
Payment by wire/bank transfer is associated with additional fees (please check with your bank for the extra fees)
and you have to consider them in your transaction.
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| Payment Mode * |
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| * Required Fields |
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