Igm Membership Form v1.2

7/17/2019 Igm Membership Form v1.2

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IGM@2015

This is an application for: Other fees payable:

MEMBER: Fee RM40 ENTRANCE: Fee RM50

LICENCIATE: Fee RM40 TRANSFER: Fee RM50

ASSOCIATE: Fee RM40

GRADUATE: Fee RM20FELLOW:(by invitation only)

Fee RM60

IGM Membership No. __________________ (for transfer of membership only)

1. PERSONAL DETAILS

TITLE : Dato’ Prof Assoc. Prof. Dr. Mr. Ms.

NAME: _________________________________________________________________________________

IDENTITY CARD NO: _____________________________________ GENDER: Male Female

PHONE [Business]: ___________________ [Home]: __________________ [Mobile] ___________________

FAX: _______________________________ EMAIL: ____________________________________________

BUSINESS ADDRESS: HOME ADDRESS:

Preferred mailing address: Business Home

2. EDUCATIONAL BACKGROUND

Name ofCollege/University/Institution

Location Degree YearField / Major

Subject(s)

APPLICATION FOR MEMBERSHIP

Please affix a recent passport-sized

photograph

INSTITUT GEOLOGI MALAYSIAINSTITUTE OF GEOLOGY MALAYSIA

c/o Board of Geologists, 19th Floor, Tabung Haji Building,

Jalan Tun Razak, 50658 Kuala Lumpur, Malaysia.

Tel: 603-21611033 ext. 225 | Fax: 603-21611184 | Email: [email protected]



IGM@2015

3. OTHER PROFESSIONAL QUALIFICATION

Date Organization/College/University Title of Course Remarks

4. FIELD OF EXPERTISE/SPECIAL INTEREST

Category Years Involved Reports/Papers

Regional Geology Yes No

Mineral Exploration / Mining Geology / Economic Geology Yes No

Mineralogy / Petrology / Petrography Yes No

Sedimentology / Stratigraphy / Paleontology Yes No

Petroleum Geology Yes No

Engineering Geology / Hydrogeology Yes No

Environmental Geology Yes NoStructural Geology / Tectonics Yes No

Geophysics Yes No

Others (please specify) Yes No



5. AFFILIATION WITH OTHER PROFESSIONAL BODIES

Name Of Organization Class Of Membership Year Joined Position Held

6. EMPLOYMENT HISTORY

Employer From To Position Held Company Activities

Instructions:

Please attach:

i) Payment with your application. All cheques (crossed), bank drafts, Money Orders or Postal Orders are to be

made in favour of Institut Geologi Malaysia and must include sufficient clearing charges.

You may also deposit cash or cheque into IGM’s bank account and attach a copy of the deposit slip with this

form. CIMB Bank Current Account Number 1440-0006703-05-8ii) Certified copy/copies of Academic and Professional Qualifications.

iii) Relevant document(s) to substantiate your field of expertise.

iv) Short resume of yourself in not more than 150 words for inclusion in the“DIRECTORY OF GEOLOGISTS”.



IGM@2015

7. SPONSORS’ CERTIFICATION FOR ADMISSION

We, the following, attest that to the best of our knowledge the details contained in this application

form by __________________________________________ are true and honest. We further attest

that we have known the said applicant in proximity for a number of years as per stated and considerhim/her to be a fit person to be admitted as a member of the Institute Geology Malaysia.

I. Name: ______________________________________ Membership No: ___________________

Identity Card No : _____________________________ Tel No: __________________________

Email: ______________________________________ Known applicant for: ___________ (yrs)

_____________________________________________ Date: __________________________

SIGNATURE OF FIRST SPONSOR

II. Name: ______________________________________ Membership No: ___________________

Identity Card No : _____________________________ Tel No: __________________________

Email: ______________________________________ Known applicant for: ___________ (yrs)

____________________________________________ Date: __________________________

SIGNATURE OF SECOND SPONSOR

8. DECLARATION

Have you ever been:

convicted of a crime? Yes No

a defendant in a civil action arising out of the practice of geology? Yes No

indicted for / convicted of felony or misdemeanor other than a traffic

violation? Yes No

subjected to an investigation, injunction or penalties concerning any

alleged consumer, investor or securities fraud? Yes No

If you answered yes to any of the above questions, please provide an explanation of the charges andthe final judgment and why these charges and judgments are not pertinent to your professional

standing and should not be considered in this application. Attached additional sheets if necessary.



IGM@2015

In affixing my signature to this application, I declare that all statements made herein are true and

accurate. I further agree to fully cooperate with IGM in the processing of my application and to

furnish any additional information as so requested. I hereby grant IGM permission to contact the

listed employers, sponsors and any others to verify information contained herein as well as to obtain

any information that may be pertinent to this application.

Name: ___________________________________

Date: _____________________

______________________________

SIGNATURE OF APPLICANT

Space below this line for Council use only.

Date received: ___________________ Date approved: __________________

Amount paid RM: ________________ Membership No.: _________________

Secretary/Membership Committee: President:

____________________________ ____________________________

(Signature) (Signature)

Recognition:Fellows, Members and Licentiates are designated by the abbreviation F.I.G.M., M.I.G.M. and L.I.G.M. respectively.Graduate Members are not assigned any abbreviation. The abbreviation denotes the bearer as a geologist who observes

and is bound by the Code of Ethics as laid down by IGM. The Council has the right to expel or suspend any member whois guilty or contravenes the IGM Code of Ethics or any laws introduced to govern the conduct of a geologist followingprocedures specified in the IGM Constitution.


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ABOUT INSTITUTE OF GEOLOGY MALAYSIA (IGM)

Institute of Geology Malaysia, also known as IGM, was officially registered with the Malaysian Registrar of Societies in1989. Its establishment was in response to the need of a single body to regulate the profession of geology in Malaysia.The Seal of IGM portrays a hammer flanked by silhouette maps of Peninsular Malaysia and East Malaysia. The Sealdepicts the basic tool of the geologists and thus symbolizes the roles of geologists in Malaysia. The objectives of IGM areas follows:

To provide a central organization for geologists in the form of a learned and scientific institute for geology and toprovide for the definition of, and qualification for, the various branches of the profession of the geological sciences.

To promote friendly interaction amongst geologists and to hold meetings for readings and discussion of mattersrelating to geology and their various arts and sciences connected therewith.

To regulate and uphold the dignity, standing and reputation of the profession of geology. To promote and advance the knowledge, study and practice of geology and the various arts and sciences connected

therewith. To assist, advise and cooperate with government departments and other private or public bodies in an honourary

capacity on questions relating to the science of geology and policy in respect of land and earth resource utilisationand all other matters connected therewith.

1. There are five classes of membership in IGM, namely Fellow, Member, Licenciate, Associate and GraduateMember .Fellows, Members and Licenciates are Corporate Members of the Institute.

2. All applications for membership must be proposed by two Corporate Members, one of whom must certify his/her personnel knowledge of the applicant.

3. A candidate for election to the class of Graduate Member must have a Bachelor's Degree with Honours in Geologyrecognized by the Government of Malaysia or equivalent qualification*.

4. A candidate for election to the class of Licenciate must not be less than twenty-one years of age and must posses thefollowing qualifications:a) at least a Diploma in Geology or equivalent qualificationb) experience in a branch of geology of at least five years durationc) passed the membership examinations, if any, athough the Council may exempt a candidate from whole or part of

these examinations if he or she has passed other recognized external examinations approved by the Council, andd) be a fit and proper person to become a Licenciate

5. A candidate for election into the class of Member must not be less than twenty-one years of age and must posses thefollowing qualifications:a) a Bachelor's degree with Honours in Geology from a University or Institution of Higher Learning recognized by the

Government of Malaysia or equivalent qualification,b) professional experience in a branch of geology of at least three years duration which should include at least one

year responsible work in geology, andc) be practising the profession at the time of application and be a fit and proper person to become a Member

6. A candidate for transfer or election into a class of Fellow shall posses the following qualifications:a) be a Member or have satisfied the conditions for admission to the class of Member b) at least fifteen years of professional experience in the geology profession of which at least five years should have

been spent in responsible charge of important geological operations or should have been spent as a consultant or advisor in the branches of geology provided that the training and technical experience of the candidate engaged asa consultant or advisor justified such professional status,

c) be practising at the time of application and satisfy the Council that he or she is a fit and proper person to become aFellow

7. A candidate for election into the class of Associate Member shall be a person who has a diploma or degree in anyprofessional discipline other than geology. He/She has demonstrated a keen interest in geology and has worked inprojects or areas which required input by geologists.

8. All applications must be made on a form prescribed by IGM.

* Equivalent Qualification:

i) A minimum of 3 years course duration in an Institute of Higher Learning which offers a degree recognised by theMalaysian Government Public Service Department (JPA).

ii) The course must be examination-based and must have at lease 50% credit hours in

the basic principles of geologyor any geoscience branches.

iii) A qualification accepted by the Board of Geologists for the purpose of registration as a Professional Geologistunder the Geologists Act upon being gazetted.

Igm Membership Form v1.2

Documents

Transcript of Igm Membership Form v1.2