Application for grAde of member of engineers Australia

Join Engineers Australia and reap the rewards

the grade of member is open to those who hold an engineers Australia accredited or recognised Australian tertiary qualification in engineering, and have now gained a number of years experience in the engineering industry. 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 gained greater responsibilities that will entail a higher degree of interaction with both internal and external stakeholders. engineers Australia offers a great range of benefits designed to enhance this stage of your career, and by becoming a member you can: apply for Chartered Status, Australias most nationally and internationally recognised certification 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 Australia magazine access a wide range of exclusive offers to assist you professionally, personally and financially

Please affix your passport-style photograph here

member referrAl
Yes No Were you referred by a member to join Engineers Australia? If you answered yes, please advise brief details of the person who recommended you join. Full Name: .......................................................................................................... Membership No: ................................................(optional)

PerSonAl detAilS (PleASe Print cleArlY)

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

Family Name: ............................................................................................................................................................................................................ Given Names (in full): ............................................................................................................................................................................................ Preferred Name: ....................................................................................................................................... Date of Birth: ........../........../..........
day month year

Membership No: ........................................................................... Contact ID: ..................................................................................................

(if already a member) (quoted on any existing correspondence, if not already a member)

Private Address Street: .............................................................................................. ............................................................................................................. Suburb/City: .................................................................................. State: ...................................Post Code: ....................................... Country: .......................................................................................... Phone: ............................................ Fax: ........................................ Email: ............................................................................................... Mobile: .............................................................................................

business Address Employer: ........................................................................................ Street: .............................................................................................. ............................................................................................................. Suburb/City: .................................................................................. State: ...................................Post Code: ....................................... Country: .......................................................................................... Phone: .............................................Fax: ....................................... Email: ............................................................................................... Mobile: .............................................................................................

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 Structural

ITEE (Information, Telecommunications and Electronics Engineering)

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MEMBER
Version: April 2012

contAct detAilS (PleASe tick Preferred contAct)

Application for grAde of member of engineers Australia (continued)

occuPAtionAl cAtegorY (PleASe tick relevAnt box)
Professional engineer mieAust Eligible for GradIEAust Minimum of three years acceptable work experience at the level of Professional Engineer

engineering technologist tmieAust Eligible for GradTIEAust Minimum of three years acceptable work experience at the level of Engineering Technologist

engineering Associate AmieAust Eligible for GradAIEAust Minimum of three years acceptable work experience at the level of Engineering Associate

evidence reQuired in SuPPort of APPlicAtion

Original certified 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) Verified Curriculum Vitae (see below note 1) setting out details of work experience Please note, if supplying your degree testamur it MUST state your discipline/specialisation. Otherwise a certified complete academic transcript must be submitted. Note 1 Verified Curriculum Vitae - must be verified by a Member or Fellow of Engineers Australia, or a person of equivalent standing, who can personally confirm the accuracy of the statements made. This can be an engineer who you have worked with or under (e.g. supervisor, engineering director). The verifier 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 verifier is required. Note 2 Certified copy - must be certified as a true copy by a person who has sighted the original document. The certifier may be a Graduate, Member, or Fellow of Engineers Australia, an Engineers Australia staff member or a person authorised to sign Statutory Declarations such as a Justice of the Peace.

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 Australia Membership 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)

method of payment (Please tick appropriate box) Money Order or Cheque drawn in $A on an Australian bank and payable to Engineers Australia International Money Order payable to Engineers Australia Credit Card (see opposite) tick box if receipt required Invoice PDP Company NOTE: Authorisation required in full at section above.
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credit card details Please charge my credit card (tick one) American Express Visa Mastercard Diners

Card No: ............................................................................................................. Expiry: .........../...........

month year

Amount: $ ............................

Name on Card: ................................................................................................. Signature: ............................................................ Date: ......../........./........

day month year

Your PrivAcY oPtionS (Your reSPonSe Will determine hoW We hAndle Your PerSonAl informAtion)
note: by joining and remaining a member of engineers Australia you consent to engineers Australia disclosing: that you are a member of engineers Australia your category (if any), grade and title of membership Question 1 i consent to my name and address information being used for the purpose of mailing to me offers by endorsed partners that participate in engineers Australias member benefits Program. Question 2 i consent to my name and address information being used for the purpose of mailing to me offers by other providers of goods and services deemed by engineers Australia to be of benefit or interest to me. Question 1 Endorsed partners offer you special discounts or benefits on services such as car hire, home loans, credit cards or insurance. These offerings are popular and are taken up by many members. To receive by mail the offering of our current and future endorsed member benefit partners, tick Agree. Agree do not Agree

Question 2 These offerings include products, services and conferences of a technical nature or in a geographical grouping targeting engineering consumers and practitioners. This includes offering from Engineering Education Australia. We only consent to those requests that we believe are in the interest of our members. To receive by mail information on products, services and conferences aligned to the activities of engineers, tick Agree. Agree do not Agree

Question 3 i consent to my information being used for the purpose of receiving the weekly engineers Australia electronic newsletter.

Question 3 e-news is emailed to members by our wholly-owned subsidiary Engineers Media. We provide them with a current membership email listing for this purpose. NB this does not apply to the magazine or to Division or college/society newsletters or transactions. To receive the weekly Engineers Australia electronic newsletter e-news tick Agree. Agree do not Agree

To view the full Privacy Policy, please visit www.engineersaustralia.org.au/privacy

Original certified copy of degree testamur/ academic transcript or Engineers Australias letter of assessment, certifying equivalence with an Australian qualification (unless already a Graduate member of Engineers Australia) Verified Curriculum Vitae setting out work experience Please see Note 1 on page 2 of this application form

Original certified copy of photo identification (either passport bio-date page or Australian drivers licence or birth certificate) Relevant payment Signed and completed Application Form, with a passport-style photo PDP Registration Authority - optional Privacy Options completed

APPlicAntS declArAtion
I agree, if admitted to membership, to be bound by the provisions of the Royal Charter and By-Laws of Engineers Australia and the ethical standards set out in Engineers Australias Code of Ethics. I certify that the statements made 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 fitness 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 my membership, and only whilst I remain a financial member. Signature: .............................................................................................................................................................. Date: ........./........../..........
day month year

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MEMBER

APPlicAntS checkliSt

Application for grAde of member of engineers Australia (continued)

fee Schedule for grAde of member of engineerS AuStrAliA

engineers Australia membership year is July - June

Please note: regardless of when you join, the membership fee covers until 30 June 2013.

reSiding in AuStrAliA (gSt incluSive):

Please note: A new member Admission fee of $82.50 applies A membership readmission fee of $82.50 applies

full Year (applies to members from 1 July 2012) grade/category Member Professional engineer engineering technologist $503.80 $394.90 engineering Associate $256.30

half Year (applies to members joining 01 January 2013 30 June 2013) grade/category Member Professional engineer engineering technologist $251.90 $197.45 engineering Associate $128.15

reSiding overSeAS (gSt excluSive):

Please note: A new member Admission fee of $75.00 applies A membership readmission fee of $75.00 applies

full Year (applies to members from 1 July 2013) grade/category Member Professional engineer engineering technologist $458.00 $359.00 engineering Associate $233.00

half Year (applies to members joining 01 January 2013 30 June 2013) grade/category Member Professional engineer engineering technologist $229.00 $179.50 engineering Associate $116.50

engineerS AuStrAliA contAct detAilS

Please send your originAl application to your local division office. Engineers Australia cannot accept faxed or emailed applications.
national office Engineering House 11 National Circuit BARTON ACT 2600 Ph: (02) 6270 6555 Fax: (02) 6273 1488 canberra division Engineering House 11 National Circuit BARTON ACT 2600 Ph: (02) 6270 6519 Fax: (02) 6273 2051 Queensland division 447 Upper Edward Street BRISBANE QLD 4000 Ph: (07) 3832 3749 Fax: (07) 3832 2101 Sydney division Level 3, 8 Thomas Street CHATSWOOD NSW 2067 Ph: (02) 9410 5600 Fax: (02) 9410 0000 South Australia division Level 11, 108 King William Street ADELAIDE SA 5000 Ph: (08) 8202 7100 Fax: (08) 8211 7702 Western Australia division 712 Murray Street WEST PERTH WA 6005 Ph: (08) 9321 3340 Fax: (08) 9481 4332 victoria division Level 2, 21 Bedford Street NTH MELBOURNE VIC 3051 Ph: (03) 9329 8188 Fax: (03) 9326 6515 newcastle division 122 Parry Street NEWCASTLE WEST NSW 2302 Ph: (02) 4926 4440 Fax: (02) 4929 7121 northern division GPO Box 417 DARWIN NT 0800 Ph: (08) 8981 4137 Fax: (08) 8941 3449 tasmania division Royal Engineers Building 2 Davey Street HOBART TAS 7000 Ph: (03) 6234 2228 Fax: (03) 6234 2216

Any questions? Email us at memberservices@engineersaustralia.org.au

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www.engineersaustralia.org.au