APPLICATION FOR STUDENT MEMBERSHIP (TYPE or BLOCK CAPITALS please)

Surname:

Current Employer:

Forenames:
Home address:

Business address:

Tel:
Email:
Job Title:
Preferred address for correspondence:
Home
Business

Tel:
Mobile:
Email:
DOB: dd/mm/yyyy
Title (Mr/Ms/Miss/Mrs):

Engineering Qualifications (please list all relevant qualifications & attach copy parchments if applicable)
Qualification
Awarded

Grade
Awarded

Institution/University

Duration
of
course

Full time/ Part

time

Discipline

Entry Year

Graduation
Year

Membership of other Professional Bodies

Name of Organisation

Abbreviated title

Current or past

Year of admission

Area of specialism: (tick up to three boxes)

Accident investigation
Bridges/Structures
Contracts Management
Development Control

Drainage
Highway Engineering
Highway Construction Maintenance
Highway/Road Design

Planning
Surveying
Traffic Engineering Management
Traffic Signs/Signals

OTHER:.
ATTACH A COPY OF YOUR CURRENT STUDENT IDENTIFICATION. Eg Scanned copy of your student card

Statement by Applicant
I hereby apply for membership of the INSTITUTE OF HIGHWAY ENGINEERS and enclose the fees listed on my
completed Payment Form. I declare that the information I have given is complete and correct. I will abide by the Articles,
Bye-Laws and Rules of the Institute and by the Codes of Conduct of the Institute and of the Engineering Council when I
am registered. I undertake to meet my professional development commitments and I will promote the objects of the
Institute to the best of my ability.

Signature:
FOR OFFICE USE ONLY:
Date received:
Date acknowledged:

Date:

Amount Paid:
CV received:

P-No:
M-Ship No:

INSTITUTE OF HIGHWAY ENGINEERS, De Morgan House, 58 Russell Square, London, WC1B 4HS.
Tel: 020 7436 7487 Fax: 020 7436 7488
Email: membership@theihe.org