This part of the the form must be completed in its entirety.

What is your name? First Middle Initial Last What is your email address? What is the name of your institution? Select Your Institution Case Western Reserve University Columbia University Cooper Union Drexel University Florida International University New Jersey Institute of Technology Ohio State University Polytechnic University University of Pennsylvania University of South Carolina Other or Non-Applicable Please select the category that applies to you: Select Your Category Faculty Student Coordinator Minority Engineer

Please click on the SUBMIT button at the end of the form upon completion.

What is your current title(s)/position(s)? (i.e. Student, Professor etc.) What is the highest academic degree you have earned? (i.e. M.Sc., Ph.D., or blank if Not-Applicable) What is your affiliation(s)? (i.e. Department, Institute, College) Please enter each affiliation on a seperate line. Office Address Street City State Zip Home Address (Optional) Street City State Zip Office Phone () - Fax () - Home Phone (Optional) () - Home-Page Address: (If applicable. Please type in the complete URL) Laboratory Home-Page Address: (If applicable. Please type in the complete URL) Academic Interests: (Teaching, Research & Professional) Please enter each interest on a seperate line. Seminar Titles: (If Applicable) Please enter each title on a seperate line. Resume: This field is optional. If your resume already exists in your personal home-page you have provided above, you do NOT need to enter it again. If you wish to include your resume, you may do so by either by typing it in the field below or using 'copy-paste' functions from your favorite text editor. User-Id and password These will be used for personal profile update and modification purposes. You will recieve your user-id in a confirmation e-Mail message which will be mailed to you upon submission of this form. Please enter a password: (i.e. one2many or bugsbunny etc.) Please re-enter the same password: Personal Picture Please use the following link to e-mail your digital passport size photograph as an attachment. Plase use GIF as the format of your picture and make sure that the GIF file is named as your last name (only) plus '.GIF' extention. Once you open Netscape's email tool, you can attach your GIF file by clicking on the 'Paper Clip' icon and locating the file on your hard drive. Plase make sure that the subject of your message is 'Picture of First-name Last-name'. In the body of your message please include your full name, your institution and your email address on seperate lines. NOTE: Your picture will be displayed 63 pixels wide and 71 pixels high (2.15x2.5cm or 0.847x0.986in). If your picture is at a different size it will be reduced to the given size. [Click here to e-mail your picture]