THE INSTITUTION OF ELECTRONICS AND TELECOMMUNICATION ENGINEERS
2, INSTITUTIONAL AREA, LODI ROAD, NEW DELHI 110003

NOMINATION FORM FOR IETE AWARDS - 2007

1. NAME OF THE NOMINEE (as it appears in official records) ______________________________________________________
   
   Present occupation (Position, organisation) _______________________________________________________________________
   
   Office Address (including fax and e-mail) _________________________________________________________________________
   
   ______________________________________________________________________________________________________________
   
   Residential Address ____________________________________________________________________________________________
   
   Phone No. (O) ____________________________ (R) ___________________Mobile No ___________________________
   
   Fax No.______________________ e-mail______________________________
   
   Age and Date of Birth ______________________________________________________________________
   
   
2. (a) Education
   Degree                                                             Year                                                               University / Institution
   
   
   
   
   
   
   
   
   (b) Membership of Professional Society (ies) with category of membership.
   
   
   (i)
   
   
   (ii)
   
   
   (iii)
   
   
   3. PROPOSED CITATION (not more than 50 words highlighting the nominee’s significant contributions).