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PERSONAL DETAILS
ID Number
First Names
Date of birth Age
Nationality
By birth
By naturalisation
Town and country of birth
Home address

Code
Home Tel number
Work address

Code
Work Tel Number

Fax

Cel
E-mail address
Supported by
EMPLOYMENT DETAILS
Employer's Name
Employer's postal address

Code
Current designation / Job title


Period in service (months)


Nature of work


Degree of responsibility
PROFESSIONAL REGISTRATION
1. Are you a registered Professional Engineer? Certificate number

2. Are you a registered Professional Natural Scientist? Certificate number

3. Membership of other Technical or Scientific Societies (include membership number and grading):
QUALIFICATIONS
Please attach a copy of your CV.
DECLARATION BY APPLICANT

I, the undersigned hereby declare that:

  1. If elected to membership of the Institute or transferred to a higher grade, I will be governed by the Constitution and By-Laws of the South African National Institute of Rock Engineering now in force or as they may hereafter be amended
  2. I will advance, as far as shall be in my power, the objects of the Institute.
  3. The statements made by me in this form are true and correct
I agree Date
PROPOSER / SUPPORTER (must be a member of the Institute)

The above applicant is desirous of election or transfer to a higher grade in the South African Institute of Rock Engineering.
We the undersigned declare that:
1. The applicant is a suitable person for membership of the Institute.
2. The statements made by the applicant are true to the best of our knowledge

Proposer's Name

Proposer's e-mail address

Proposer's Tel number


 

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