Transformers Committee
Application for Membership
Appendix B

Name ____________________________________________________________________________________

Company _________________________________________________________________________________

Address___________________________________________________________________________________

Telephone:_____________________________________Fax: _______________________________________

IEEE Member Grade_____________________________IEEE Member________________________________

Member PES? |_| Yes |_| No

Please note membership eligibility requirements on reverse.

List principal subcommittee and working group activity. This application is to be signed by the respective chairmen as references. At least one reference must be a subcommittee chairman, who will sponsor the applicant.

1. Subcommittee/Working Group ______________________________________________________________

Duration ______________Chairman (Signature) __________________________________________________

2. Subcommittee/Working Group ______________________________________________________________

Duration ______________Chairman (Signature)___________________________________________________

3. Subcommittee/Working Group ______________________________________________________________

Duration ______________Chairman (Signature)___________________________________________________

Check the classification most appropriate for your position:

|_| Producer or Manufacturer Interests - Those directly concerned with the production of products which are covered by documents prepared by the Transformers Committee.

|_| Consumer or User Interests - Those who apply or use products which are covered by documents prepared by the Transformers Committee.

|_| General Interest - Those who have interests other than those described above.

Signed _________________________________________________ Date:___________________________

Approved by Administrative Subcommittee:

Chairman _______________________________________________Date:___________________________