Milestones:Plaque Order Form

                                                          MILESTONE PLAQUE ORDER FORM

(NOTE: THE MILESTONE PROPOSAL MUST HAVE PASSED THROUGH THE ENTIRE APPROVAL PROCESS AND OBTAINED FINAL BOARD OF DIRECTORS APPROVAL BEFORE PLAQUE(S) MAY BE ORDERED.)

PLAQUES REQUIRE 8 WEEKS TO CAST AND SHIP. THIS TIME CANNOT BE SHORTENED. Please ensure that there is enough time between your placing the order and the dedication ceremony for the plaques to arrive on time.

The month and year of the dedication are cast on the plaque(s). Thus the date of the dedication must be decided prior to the ordering of the plaques.


(Please print, fill out, and scan this order form. (For a printer-friendly version, click on "Printable Version" under "Tools" in the grey box to the left.) Please email filled-out form to: Milestones Administrator, IEEE History Center, Stevens Institute of Technology, Samuel C Williams Library 3rd Floor, Castle Point on Hudson, Hoboken, NJ 07030, USA, +1 732 562 5468, r.colburn@ieee.org )

Plaques cost US$835 per plaque plus shipping. Current shipping costs per plaque are:
Within U.S.A.: $70,to Canada: $100, to Europe: $160, Asia and Pacific: $375. Other destinations vary. IEEE History Center staff can supply costs to you on request. There is no discount in cost for multiple plaques. For details, see Plaque payment options


Name of Milestone: ________________________________________

Docket Number of Milestone: ________________________________ (Example: 2014-02. Docket numbers can be found on the Milestones Status Report)


Date of Milestone ceremony: ________________________________

Number of plaques: _______________________________________


If there will be versions of the plaque in other languages, please list the name and email of the person who will supply the translation(s):

Translator’s name: ___________________________________

Translator’s email: ___________________________________



Name and street address of person to ship plaques to (FedEx cannot deliver to post office boxes:

Name:______________________________

Address:_____________________________

______________________________

_______________________________

_______________________________


Telephone number of person to ship plaques to (necessary for FedEx label in case of problems with customs or delivery):___________________________

Email address of person to ship plaques to: _____________________________ (so that IEEE History Center staff can email them the tracking numbers)

Are there any shipping or customs details of which we should be aware? _________________
____________________________________________________________________________

Name and email address of the person to invoice for the plaques (i.e. Treasurer of the sponsoring IEEE organizational unit). In cases where a corporation or other non-IEEE organization has agreed to pay for the plaque(s), it is the IEEE organizational unit’s responsibility to obtain payment from the non-IEEE sponsor and for the IEEE organizational unit(s) to reimburse the History Center. The IEEE History Center may not invoice the non-IEEE sponsor.

Name: _________________________________________

Email:__________________________________________


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