memberapplication_cm0412_1

7/30/2019 memberapplication_cm0412_1

1/4

M E M B E R

t a m s p s w a e s A s a a a s

A s a a a y q a a , a a w a a y a s p s y.You will have now cemented your place in the engineering team, and are continually extending your professional repertoire, enhancing skills and gaining further experience. You will have gainedgreater responsibilities that will entail a higher degree of interaction with both internal and externalstakeholders.

e s A s a a s a a a s s a s s a y a , a y a y a :

apply for Chartered Status, Australias most nationally and internationally recognised certi cation of competency in engineering

further strengthen your networks through any one of Engineers Australias learned groups receive monthly editions of the industrys most respected publication, Engineers Australiamagazine access a wide range of exclusive offers to assist you professionally, personally and nancially

App a grAde of member e s A s a a

Join Engineers Australia and reap the rewards

PAge 1 4

Please af x yourpassport-style

photograph here

PerSonAl detAilS (PleASe Print cleArlY)

member referrAl

Title: Dr Mr Mrs Ms Miss Other(please specify) .......................... Gender: Male Female

Family Name: ............................................................................................................................................................................................................Given Names (in full): ............................................................................................................................................................................................

Preferred Name: ....................................................................................................................................... Date of Birth: ........../........../..........

Membership No: ........................................................................... Contact ID: ..................................................................................................(if already a member) (quoted on any existing correspondence, if not already a member)

day month year

contAct detAilS (PleASe tick Preferred contAct)

P a A ss

Street: ..............................................................................................

.............................................................................................................Suburb/City: ..................................................................................

State: ...................................Post Code: .......................................

Country: ..........................................................................................

Phone: ............................................Fax: ........................................

Email: ...............................................................................................

Mobile: .............................................................................................

b s ss A ss

Employer: ........................................................................................

Street: ...........................................................................................................................................................................................................

Suburb/City: ..................................................................................

State: ...................................Post Code: .......................................

Country: ..........................................................................................

Phone: .............................................Fax: .......................................

Email: ...............................................................................................

Mobile: .............................................................................................

Were you referred by a member to join Engineers Australia? Yes NoIf you answered yes, please advise brief details of the person who recommended you join.

Full Name: .......................................................................................................... Membership No: ................................................(optional)

Version: April 2012

engineering PrActice (PleASe Select one)These colleges broadly cover all disciplines of engineering. Please select a college closest to your area of specialisation:

Biomedical Chemical Civil Electrical Environmental Mechanical

ITEE (Information, Telecommunications and Electronics Engineering) Structural


2/4

App a grAde of member e s A s a a ( )

PAge 2 4

occuPAtionAl cAtegorY ( PleASe tick relevAnt box)

P ss a e

mieA s Eligible for GradIEAust

Minimum of three years acceptable work experience at the level of Professional Engineer

e t s

tmieA s Eligible for GradTIEAust Minimum of three years acceptable work experience at the level of Engineering Technologist

e Ass a

AmieA s Eligible for GradAIEAust Minimum of three years acceptable work experience at the level of Engineering Associate

Note 1 Veri ed Curriculum Vitae - must be veri ed by a Member or Fellow of Engineers Australia, or a person of equivalent standing,who can personally con rm the accuracy of the statements made. This can be an engineer who you have worked with or under (e.g. supervisor, engineering director). The veri er should make a statement as follows: I verify that this is a true statement of the career history of [candidates name] during the period [date] to [date]. The statement should be signed and dated with personal details printed below. An original wet signature of the veri er is required.

Note 2 Certi ed copy - must be certi ed as a true copy by a person who has sighted the original document. The certi er may bea Graduate, Member, or Fellow of Engineers Australia, an Engineers Australia staff member or a person authorised to signStatutory Declarations such as a Justice of the Peace.

evidence reQuired in SuPPort of APPlicAtion Original certi ed copy of degree testamur/academic transcript (see below note 2) or Engineers Australia letter of assessment

(either MSA or Stage 1 Assessment) (unless already a Graduate member) Veri ed Curriculum Vitae (see below note 1) setting out details of work experiencePlease note, if supplying your degree testamur it MUST state your discipline/specialisation. Otherwise a certi ed completeacademic transcript must be submitted.

c ca d a s Please charge my credit card (tick one)

American Express Visa Mastercard Diners

Card No: .......................................................................................................

Expiry: .........../........... Amount: $ ............................

Name on Card: ..............................................................................................

Signature: ............................................................ Date: ......../........./........day month year

month year

m pay (Please tick appropriate box)

Money Order or Cheque drawn in $A on anAustralian bank and payable to Engineers Australia

International Money Order payable to Engineers Australia

Credit Card (see opposite)

t p q

Invoice PDP CompanyNOTE: Authorisation required in full at section above.

memberShiP SPonSorShiP (ProfeSSionAl develoPment ProgrAm onlY)

I will be applying to join the Professional Development Program (PDP) pathway in eChartered.My organisation (Insert name) ....................................................................................................has agreed to fully sponsor my Engineers AustraliMembership fee for the duration of my time on its Professional Development Program.Organisation PDP Coordinator Name: ...........................................................................................................................................................................PDP Organisation Account Name: .................................................................................................................................................................................

Signature: ....................................................................................................................................................................................................... Date: ......Not all PDP Partners sponsor the Engineers Australia membership of its PDP Participants.I understand that if my organisation does not or discontinues to sponsor my membership fees, I will be responsible for payment.

Signature of Applicant:...................................................................................................................................................................

day month year

PAYment ( PleASe refer to fee Schedule on bAck PAge)


3/4

PAge 3 4M E

M B E RAPPlicAntS checkliSt Original certi ed copy of degree testamur/

academic transcript Engineers Australias letterof assessment, certifying equivalence with anAustralian quali cation (unless already a Graduatemember of Engineers Australia)

Veri ed Curriculum Vitae setting out workexperience Please see Note 1 on page 2 of thisapplication form

Original certi ed copy of photo identi cation(either passport bio-date page Australian drivers

licence birth certi cate) Relevant payment

Signed and completed Application Form, with apassport-style photo

PDP Registration Authority - optional

Privacy Options completed

Your PrivAcY oPtionS (Your reSPonSe Will determine hoW We hAndle Your PerSonAl informAtion)

n :by j a a a e s A s a a y s e s A s a a s s :

a y a a e s A s a a y a y ( a y), a a s p

Q s 1i s y a a a ss

a s p p s a s y

s pa s a pa pa e s A s a as m

b s P a .

Endorsed partners offer you special discounts orbene ts on services such as car hire, home loans,credit cards or insurance. These offerings are popularand are taken up by many members. To receive bymail the offering of our current and future endorsedmember bene t partners, tick Agree.

Q s 1

A

d n A

Q s 2

i s y a a a ssa s p p s a sy p s s as s y e sA s a a

s .

These offerings include products, services andconferences of a technical nature or in a geographicalgrouping targeting engineering consumers andpractitioners. This includes offering from EngineeringEducation Australia. We only consent to thoserequests that we believe are in the interest of our members. To receive by mail information onproducts, services and conferences aligned to theactivities of engineers, tick Agree.

Q s 2

A

d n A

Q s 3i s y a s p p s w y e s A s a a

ws .

e-news is emailed to members by our wholly-ownedsubsidiary Engineers Media. We provide them witha current membership email listing for this purpose.NB this does not apply to the magazine or to Divisionor college/society newsletters or transactions. Toreceive the weekly Engineers Australia electronicnewsletter e-news tick Agree.

Q s 3

A

d n A

APPlicAntS declArAtionI agree, if admitted to membership, to be bound by the provisions of the Royal Charter and By-Laws of EngineersAustralia and the ethical standards set out in Engineers Australias Code of Ethics. I certify that the statementsmade by me in this application are correct. I understand that I have an obligation to inform Engineers Australia

of any matter that may affect my tness for membership including the conviction of any crime in any country.I agree to only use the post-nominals of membership appropriate to the occupational category and grade of mymembership, and only whilst I remain a nancial member.

Signature: .............................................................................................................................................................. Date: ........./........../..........day month year

To view the full Privacy Policy, please visit www. sa s a a. .a /p a y


4/4

App a grAde of member e s A s a a ( )

PAge 4 4

w w w

. e n g i n e e r s a u s t r a l i a

. o r g

. a u

fee Schedule for grAde of member of engineerS AuStrAliA

reSiding in AuStrAliA (gSt incluSive) :P as : A n w m A ss f $82.50 app s

A m s p r a ss f $82.50 app s

f Y a (app s s 1 J y 2012)

g a /ca y P ss a e e t s e Ass a

Member $503.80 $394.90 $256.30

ha Ya (app s s j 01 Ja a y 2013 30 J 2013)


Member $251.90 $197.45 $128.15

reSiding overSeAS (gSt excluSive) :P as : A n w m A ss f $75.00 app s

A m s p r a ss f $75.00 app s

f Y a (app s s 1 J y 2013)


Member $458.00 $359.00 $233.00

ha Ya (app s s j 01 Ja a y 2013 30 J 2013)


Member $229.00 $179.50 $116.50

CM0412

Any questions? Email us at [email protected]

engineerS AuStrAliA contAct detAilS

na a oEngineering House11 National CircuitBARTON ACT 2600Ph: (02) 6270 6555Fax: (02) 6273 1488

ca a d sEngineering House11 National Circuit

BARTON ACT 2600Ph: (02) 6270 6519Fax: (02) 6273 2051

Q s a d s447 Upper Edward StreetBRISBANEQLD 4000Ph: (07) 3832 3749Fax: (07) 3832 2101

Sy y d sLevel 3,8 Thomas Street

CHATSWOOD NSW 2067Ph: (02) 9410 5600Fax: (02) 9410 0000

S A s a a d sLevel 11,108 King William StreetADELAIDE SA 5000Ph: (08) 8202 7100Fax: (08) 8211 7702

W s A s a a d s712 Murray StreetWEST PERTH

WA 6005Ph: (08) 9321 3340Fax: (08) 9481 4332

v a d sLevel 2,21 Bedford StreetNTH MELBOURNE VIC 3051Ph: (03) 9329 8188Fax: (03) 9326 6515

n w as d s122 Parry StreetNEWCASTLE WEST

NSW 2302Ph: (02) 4926 4440Fax: (02) 4929 7121

n d sGPO Box 417DARWIN NT 0800Ph: (08) 8981 4137Fax: (08) 8941 3449

tas a a d sRoyal Engineers Building2 Davey Street

HOBART TAS 7000Ph: (03) 6234 2228Fax: (03) 6234 2216

Please send your originAl application to your local division of ce. Engineers Australia cannot accept faxed or emailed applications.

e s A s a a s p y a s J y - JP as : r a ss w y j , s p s 30 J 2013.

memberapplication_cm0412_1

Documents