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WIE Promotional Material Request Form

WIE has promotional items available for Affinity Group events and activities.  To request the items, please complete and submit this form.

Items should be requested at least three-weeks prior to the event.  

If you have any questions about the items, please contact WIE at women@ieee.org.

Requester's Name and Title:
WIE Affinity Group Name:
Requester's Address:
Requester's Telephone Number:
Requester's Email:
   
Event Name and Date:
Event Location:
Event Audience:
Estimated Attendance:
   
Mail Items to (Name): (if same as above put N/A)
Date to receive promotional items:
Address to send promotional items:
Telephone Number of Individual who will receive shipment: (if same as above put N/A)
Email of Individual who will receive shipment:(if same as above put N/A)
   
Comments:

 
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