Qatar Chapter (Under the aegis of Embassy of India)

Email:- ieiqatar@gmail.com

APPLICATION FOR MEMBERSHIP

Membership Category For Office Use Paste your
Please tick whichever applicable Membership Ref…………….. photo here
Annual Membership Fee Received QR…………….
Life membership Paid by- Cash Cheque
Part A: About Yourself:
Full Name: IEI Corporate
(as in passport) Membership No.:
(* if applicable attach
copy of certificate.)

Date of Birth: DD/MM/YYYY

Nationality: Gender: M / F Passport No.:

Company you Designation:
work for:
Qatari ID No.:
Your engineering and professional qualifications (start with the highest):-* attach copy of certificates
Degree Branch/Specialisation Year University/ Institution

Are you a Chartered or Professional Engineer?- Y/ N C.E. P.E. of Country………..

(* if applicable, attach copy of certificate)

If you are a member of any other

professional body, give details:-
Your areas of Total years of Yrs.
expertise/core professional
competencies:- experience:-
Part B: Your Contacts:
Phone Office: Home: Mobile:
Fax Office: Home:
Email Primary:
Alternative:
No emails; please contact me by phone or fax

For membership correspondence, please communicate to: member.ieiqatar@gmail.com

Enclosure:- *Copy of Professional Qualification Certificates Signature