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FULL NAME _____________________________________POSITION_________________________

ORGANIZATION___________________________________________________________________

STREET ADDRESS_________________________________________________________________

CITY__________________________

STATE________ZIP CODE_______________

PHONE____/_____-_______ FAX____/_____-_______

E-MAIL____________________________ WEB______________________________

A. Name of person you are replacing (if applicable) ______________________________________

B. Classification:

( ) General Interest ( ) Electronics Mfg. ( ) Carrier 
( ) University Rep.  ( ) Pkg. Consultant  ( ) Measurement Equip. Mfg.  
( ) Other ________________

C. Sub-committee of interest:

( ) Admin.  ( ) Test Plan   ( ) Equipment    ( ) Statistical   ( ) Analysis

D. IoPP Membership Status: ( ) Member ( ) Non-Member

E. I wish to participate as:

( ) Sender or receiver of units  
( ) Preparation of dummy packages
( ) Making recording units available for study - Please list type:____________________________
( ) Committee chair, vice-chair, etc.
( ) Committee member
( ) Funding source    Details:______________________________________
( ) User of data and results generated by MADE

APPLICANT'S SIGNATURE___________________________________ DATE__________________