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, 1 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. Plaques may be paid for by four methods: Check, credit card (Visa or Mastercard), wire transfer, or transfer to IEEE History Center account from IEEE organizational unit account. (Deduction from Section rebate is not a payment option.) IEEE History Center staff will provide payment details (e.g how to arrange transfer to History Center account) on the invoice that will be sent to the IEEE organizational unit. For details, see Plaque payment options Payment must be made by an IEEE organizational unit to the History Center. In cases where a corporation or non-IEEE sponsor has agreed to support the cost of the plaque, the IEEE sponsoring organizational unit must pay the History Center and obtain reimbursement from the non-IEEE sponsor. (The only exception to this requirement is when the customs regulations of the receiving country make it easier or more cost-effective for the payment to come directly from an entity in that country. Permission must be obtained in advance from History Center staff in such cases.)



Name of Milestone: ________________________________________

Docket Number of Milestone: ________________________________ (Example: 2014-02. Docket numbers can be found on the Milestones Status Report) at http://ieeemilestones.ethw.org/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:_____________________________

______________________________

_______________________________ payment must be made to the History Center from the IEEE organizational unit.


_______________________________


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)


VAT number (if applicable): ______________________________________________

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 (e.g.. Treasurer of the sponsoring IEEE organizational unit or other financial officer). The invoice must be sent to an IEEE organizational unit because the IEEE History Center may not invoice non-IEEE sponsor(s). In cases where a corporation or other non-IEEE organization has agreed to sponsor the cost of the plaque(s), it will be the IEEE organizational unit’s responsibility to pay the History Center and to obtain reimbursement from the non-IEEE sponsor.

Name: _________________________________________

Email:__________________________________________


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