SAIEE House, 18A Gill Street, Observatory, Johannesburg, 2198
P O Box 751253, Gardenview, 2047 Tel +27-11-487-3003 Fax +27-11-487-3002
Web: http://www.saiee.org.za/
Account enquiries: Celeste Pretorius at
APPLICATION FOR ELECTION OR TRANSFER
TO ASSOCIATE/MEMBER/SENIOR MEMBER / (Office Use Only)
Application received on:
Graded by Council as:
Date of Meeting:
NOTE: THIS FORM MUST BE COMPLETED IN FULL AND LEGIBLE BLOCK LETTERS, SIGNED AND EMAILED TO PLEASE NOTE: INCOMPLETE FORMS WITHOUT RELEVANT DOCUMENTATION CANNOT BE PROCESSED AND CAUSES DELAY.
(Do not return without a signature)
Your Details:
Surname:
First names:
Title (Prof/Dr/Mr/Mrs/Ms/Miss):
Date of Birth:
ID Number:
Contact Details:
Physical Address:
Postal Address:
(if not same as physical)
Employer Name and Address:
Home: Tel: Fax: E-mail:
Office: Tel: Fax: E-mail:
Mobile:
Name and tel no. of a contact person (Not living with you):
Education/Miscellaneous:
ECSA Registration No.:
First Relevant Qualification Achieved:
Graduation Date:
Name of University/Technikon/College:
Relevant Experience After First Qualification: (years):
Present grade of membership of the SAIEE (if applicable) / …………………………………...... …
DECLARATION BY APPLICANT: I the undersigned, hereby declare that I will be governed by the Constitution and By-laws of the South African Institute of Electrical Engineers now in force or as they may be amended. I will advance the objectives of the Institute.
While a member of the Institute, I will adhere to the code of professional conduct laid down in the Constitution. (A copy of the Constitution, By-laws and Objectives are displayed on the website: www.saiee.org.za).
I also declare that the statements made by me on this form are true and correct.
SIGNATURE OF APPLICANT:...... DATE: ……………………………..
Applicants for the grade of Associate or Member are required to nominate a member of the SAIEE or a senior company official who would be prepared to vouch for the applicant’s professional experience and integrity. (Please enter the contact details of this person below).
Name: / Tel:Mobile/Cell: / Email:
Applicants for the grade of Senior Member are required to nominate at least two Senior Members or Fellows who would be prepared to vouch for the applicant’s professional experience and integrity. (Please enter the contact details of these persons below).
Name: / Tel:Mobile/Cell: / Email:
Name: / Tel:
Mobile/Cell: / Email:
A certified copy of your degree/diploma should be submitted together with the completed form. If you are already registered with ECSA, copies of your certificates are not necessary.
Payment of the Entrance and Membership Fee for the appropriate grade must accompany this application (Refer to website for Membership Subscription Rates).
Payment can be effected by cheque, electronic transfer or credit card.
Bank details.
Standard Bank, Ellis Park Branch Code: 00 46 05 Account Number: 201 547 066
Please fax deposit slip to 011 487 3002 once payment has been made.
Credit Card Details:
Card Number: ………………………………………...... Expiry Date: …………………………………
CVC Number: …………………………………… (Last 3 digits on reverse side) ......
Amount to pay: ………………………………......
TO AVOID DELAY, BEFORE SUMITTING YOUR APPLICATIONPLEASE CHECK THAT YOU HAVE DONE THE FOLLOWING:-
1. Completed the Application Form in full
2. Attached a CERTIFIED COPY of your qualifications if you are not registered with ECSA
3. Attached a copy of your CV
4. Paid your application and your SAIEE annual membership fees in full
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