APPLICATION FOR ADMISSION TO GRADE OF ASSOCIATE MEMBER

- This form is available in Afrikaans and isiZulu. - Please use black ink and block le ers. - Please complete all sec ons.

A PARTICULARS OF APPLICANT

Address (Postal ) :

Postal code:

Address (Physical ) :

Postal code: Address (Bil l ing) :

Postal code:

Employer: ioP s on:

Tel No. (H): Tel No. (W): Fax No: Cell No:

E-mail: Alterna ve Contact N o: Alterna ve E -Mail: Date of Birth: ID/Passport No: Ci zenship: Home Language: Correspondence Preference:

COMPLETING OF THIS BLOCK IS COMPULSORY! This informa on is for sta urposes and is similar to the form of the 1996 N onal Census.

How would you describe yourself?

African / Black

Coloured

Male

Indian / Asian Female

White

Disabled Y N

Other (Specify):

A f r i k a a n s E n g l i s h

Tit le: Surname: Full Name(s):

Tel +27 (0) 11 805 5947 SAICE House Block 19, Thornhill Office Park Bekker Street, Vorna ValleyMidrand , Private Bag X200, Halfway House 1685Email: membership@saice.org.za

HERITAGE ENGINEERING PEOPLE- The applicable entrance fee must be submitted with the application form.

B TERTIARY EDUCATION NB Certi ed Copies of each degree, diploma or certi cate noted in t he table below must be

a ached .

Educational Institution Quali c ation Obtained Date Obtained

C MEMBERSHIP OF OTHER INSTITUTIONS AND PROFESSIONAL REGISTRATION

NB Certi ed Copies of registra on cer ficates or membership cer ficates for each

Counci l, Ins tu on or Society noted in the table below must be a ached.

Council , Institution, Society

Grade of membership/ Registration category

Membership / Registration Number

Year of election / admission

D SAICE DIVISIONS

- You may elect to join one free division . - Geotechnical Division members also belong to the ISMMGE and have to pay the prescribed Surcharge, please refer to fee structure on SAICE website.

NB: PLEASE NOTE

- A cert ed copy of your ID/Pass port needs to be submitted with the application. - You remain a member of SAICE unti l you give written notice of your resignation.

E DECLARATION

Signature: Date:

Please ind ic ate your c hoic e

1. Transporta on Engineering 2. Geotechnical Engineering 3. Railway & Harbour Engineering 4. Water Engineering 5. Joint Structural Division 6. Environmental Engineering 7. Informa on Technology 8. Project Management and Construc on Division 9. ICE-SA, A Joint divis ion of SAICE and ICE

10. Marine Divis ion 11. F i r e E n g i n e e r i n g d i v i s i o n

I, the undersigned, certify that the information given in this application is true and correct and hereby undertake to abide by the SAICE Code of Ethics, the Constitution and the By-L

I further acknowledge that I (in my personal capacity) am responsible to keep my personal details updated on the SAICE member database and for the payment of my annual membership fee.

aws and to promote SAICE’s mission and goals when I am accepted as an Associate Member.