ZIMBABWE INSTITUTION OF ENGINEERS
ZIMBABWE INSTITUTION OF ENGINEERS
Conquenar HouseP O Box 660
256 Samora Machel Avenue East Harare
Eastlea, ZIMBABWE
HARARE Tel: 746821/746652
Email: [email protected]; [email protected]
APPLICATION FOR STUDENT MEMBERSHIP
SECTION 1 (to be completed by the applicant in capitals)
Surname
Date of Birth
First name(s)
National ID No.
Citizenship
Tel. No. (H)
Cell No
Fax No.
Postal Address
E-mail Address
SECONDARY EDUCATION
Educational Institution attended
From
To
Examinations passed
TECHNICAL/ENGINEERING EDUCATION
Educational Institution attended
From
To
Degree, Diploma or Certificate to be obtained
Engineering Discipline
*If elected I would also like to be a member of the following
specialist division(s).
(Please indicate with an X in the appropriate box)
YES
NO
AGRICULTURAL DIVISION
INDUSRTIAL & MANUFACTURING
BUILDING SERVICES
LARGE DAMS DIVISION
COMPUTER ENGINEERING
MINING & METARLLURGY
ENERGY
STRUCTURAL DIVISION
ENVIRONMENT
WATER & SANITATION
GEOTECHNICAL
Other (Specify)
Signature of Applicant ......................................
Date..............................
SECTION 2 (To be completed by the applicants sponsor, a
Corporate Member of ZIE)
Name of Sponsor:
.......................................................................................
Grade of Membership:
........................................................................................
I am pleased to confirm that the above applicant is currently
studying at
and that all above details are correct. I hereby support his/her
application for Student Membership of the Institution.
Signature:............................................. Date:
...................................
For Official Use Only - DETAILS OF PAYMENT:
Cash/Cheque/Money Order No...........................
for$.....................
Breakdown:Registration Fee$.....................
Division$.....................
