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Application For Registration For The Institute Of Geoscientists Papua New Guinea

To apply for membership please fill in the form below and attach with this form all the relevant documents.
Please provide all relevant documentation with this completed form (Section 5 and Section 7). All certificates and transcripts must be certified, any other supplementary documentation can be uploaded as a word/pdf document and emailed along with evidence of payment to admin@igpng.org. Failure to do so will deem your application as incomplete.
Completed application forms can also be submitted in hard copy form to:

The Registration Board

Institute of Geoscientists Papua New Guinea

Postal Address:

Institute of Geoscientists - PNG (IGPNG)

P O Box 192, University Post Office
Port Moresby
National Capital District

Courier Address:

The IGPNG Head Office

1st Floor, Science 3 Building

The University of Papua New Guinea

NCD, Papua New Guinea

Telephone: (675) 326 7395/ Mobile: (675) 7334 5983

Email: admin@igpng.org

2. MEMBERSHIP INFORMATION
Please check one of the following boxes*

I am a PNG Citizen applying for membership with IGPNGI am a NON-Citizen applying for membership with IGPNG
MEMBERSHIP OF OTHER SCIENTIFIC AND PROFESSIONAL ORGANIZATIONS
Type in the Organization and Membership grade
Type in the Organization and Membership grade
Type in the Organization and Membership grade

4. REFEREES

The following geoscientists are referees for my nominated Fields of Practice
1.PROPOSER*

PrefixFirst NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
IGPNG Member

YesNo
2. SECONDER*

PrefixFirst NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Email*
example@example.com
IGPNG Member

YesNo
3. REFEREE*

PrefixFirst NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
IGPNG Member

YesNo
4. REFEREE*

PrefixFirst NameMiddle NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
IGPNG Member

YesNo

Please enter your Academic Qualifications (Highest Level First)*

** Examples: geochemistry, hard-rock technology, mining geology, petroleum geophysics etc.. If you did not major in any geoscience courses please list your major subjects below. For this section (5) you are required to submit certified copies of your certificates, academic transcripts, certification of training etc.. with this application form once completed.
Upload a copy of your Academic qualifications: High School Certificate, Tertiary Degree, Post-graduate Diploma/Degree as well as Academic Transcripts and any training certification applicable to this section.*

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6. Statement of Relevant Employment and Experience

Statement of employment from three most recent employers. If you are an undergraduate and are applying for student membership please proceed to Section 8. If you are a Graduate without employment but have undertaken Industrial Training you can fill in "Industrial Trainee" under position held for Employer (1). If you are a Graduate currently employed please add your Industrial Training as well as filling in your current employment.
Employer (1)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Position Held
From

DayMonthYear
Date
To

DayMonthYear
Date
Responsibilities
Employer (2)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Position Held
From

DayMonthYear
Date
To

DayMonthYear
Date
Employer (3)
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number

Area CodePhone Number
Position Held
From

DayMonthYear
Date
To

DayMonthYear
Date
Responsibilities

7. STATEMENT OF GEOSCIENCE ACTIVITIES

Please provide a summary of the professional geoscientific activities in which you have been engaged. Give project details and your position and responsibilities for the project. Client names and commercially sensitive details are not necessary, provided the submitted details indicate adequately the contributions that you have made to the profession. If you are applying for a Student, Graduate, Technician or Associate Membership this section does not apply to you. We suggest you copy the table below as a template and complete in Microsoft word or similar program, fill in the details and upload as an attachment with this completed application form. PDF versions will also be accepted.

Type a question

	Field of Practice	Commodity or Specialty	Responsibilities and Activities	Location	Duration
1
2
3

Alternatively you can re-create the above table and upload:

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8.APPLICANTS DECLARATION

I confirm that the information provided above is true and complete:
Signature

Clear
Date

DayMonthYear
Date

Application For Registration For The Institute Of Geoscientists Papua New Guinea