Request for Visa Assistance
Please Print or Type all Information

Please note that event registration is required prior to the visa confirmation letter being issued.

Name:
Email address:
Conference Title:
Conference Dates:
Conference Location:

Are you an IEEE Member? Yes ___ No ___

If yes, provide your IEEE Member Number: _______________

Are you a speaker/presenter? Yes ___ No ___

Are you a committee member? Yes ___ No ___

Name of session you are speaking/presenting: ____________________________________________

To what post office address should the letter be mailed?

Street:

City:

State/Province:

Postal Code _________________ Country:

E-mail: