Distinguished Lecturer Submission Form

Nominee Information

Nominee Name (Last Name, First Name) (*)

Nominee Domain of Activity (*)
AcademicIndustryFellowMedicineOther

Nominee Occupation (*)

Nominee's Current Employer (*)

Nominee's Current Position (*)

Nominee Email Address (*)

Nominee Country

Nominee Website

Nominee Gender (*)
MaleFemale

IEEE Region: (*)
Region 1 (Northeastern US)Region 2 (Eastern US)Region 3 (Southern US)Region 4 (Central US)Region 5 (Southwestern US)Region 6 (Western US)Region 7 (Canada)Region 8 (Africa, Europe, Middle East)Region 9 (Latin America)Region 10 (Asia and Pacific)

Choose 1 EMBS TC for Review: (*)
Biomedical and Health Informatics (BHI)Biomedical Imaging and Image Processing (BIIP)Biomedical Signal Processing (BSP)Bionanotechnology & BioMEMS (BNM)BioRobotics (BR)Cardio-Pulmonary (CPS)Computational Biology & Physiome (CBP)Neuroengineering (NE)Therapeutic Systems and Technologies (TST)Translational Engineering & Healthcare Innovations (TEHI)Wearable Biomedical Sensors and Systems (WBSS)

Nominee IEEE Member Number

Nominee IEEE Member Grade
AffiliateAssociate MemberFellowGraduate Student MemberLife FellowLife MemberMemberSenior MemberStudent MemberHonorary Member

Nominee is an EMBS Member? (*)
YesNo

Year of Nominee's Highest Degree (*)
20182017201620152014201320122011201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900

Please enter the Nominee's lecture topics (up to three), with keywords and a short abstract for each.

Lecture Topic 1 Title (*)

Lecture Topic 1 Keywords (*)

Lecture Topic 1 Abstract (*)

Lecture Topic 2 Title

Lecture Topic 2 Keywords

Lecture Topic 2 Abstract

Lecture Topic 3 Title

Lecture Topic 3 Keywords

Lecture Topic 3 Abstract

Nominee's Teaching and/or Public Speaking Experience (*)

Summary of Nominee's EMBS Activities (*)

Upload your nomination packet below. Please note that only PDF Files are allowed with a 2MB max for each file.

Nominee CV (PDF only) (*)

Nominee Photo (PDF, PNG, JPG, JPEG) (*)

Letters of Invitation (PDF, ZIP)

Nominator Information

Nominator Name (Last Name, First Name) (*)

Nominator Affiliation (*)

Nominator Email Address (*)

Nominator IEEE Member Number

Is this a TC or Chapter-based nomination? (*)
NoYes, Technical Committee-basedYes, Chapter-based

If YES, please specify name of TC or Chapter