Indicate type of submission by placing a check mark in appropriate block. Minor changes such as a
new telephone extension or mailing address may be made by notifyin9 the Lead Standardization
Activity by telephone 615-574-7886 or FR3 624-7886. If recording termination of membership,
complete blocks 1 - 8i only.
Block 2-7 :
Enter the address of only the group with which you will have the most activity.
Enter the name and country of the organization under whose auspices the standards committee is
Enter the Secretariat Organization if different from as the parent organization. (Do not enter the name
of an individual.)
Indicate your current or planned position on the activity.
U.S. Department of Energy (DOE) representative may vote unless specifically instructed by the
Department not to vote, or if the representative is working in Departmental functions formerly assign
to the Federal Energy Administration.
Enter the approximate date (month and year) that you began or plan to begin your membership.
Enter "indefinite" in this block if you do not have a specific expiration date for membership.
DOE policy states that all Departmental employees and contractors who, at government expense,
participate in non-government standards activities should do so as an official Departmental representa-
tive. DOE employees and contractors should check the "DOE" block unless they have also been
asked to represent another group in a particular activity (e.g., asked by the members of one committee
to represent them on another committee), in which case, check the "Other" block, and specify the group
represented in addition to DOE.
Very briefly describe the scope of the activity.
DOE employees and contractors must obtain the required signature of the Departmental Element or
designated representative as Approving Official before submitting the form. Members not representing
DOE are not required to obtain approval unless internal company procedures require higher level
Acknowledgement will be made by the Lead Standardization Activity to signify entry has been made in
the DOE database. A copy of the acknowledged form will be returned to the originator.
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