Fellowship Application Form
Member Name
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First Name
Middle Name
Last Name
Current Member Category
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Date of Birth
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Day
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Month
Year
Date
Address
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Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
E-mail
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example@example.com
Mobile Number
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Area Code
Phone Number
Phone Number
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Area Code
Phone Number
Work Number
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Area Code
Phone Number
Company
*
Rules and conditions of Fellow Membership
Any individual who has been a member continuously for a period of at least ten years may be designated a Fellow by resolution of the Membership Committee in recognition of outstanding service to the Institute. The criteria for designation as Fellow are to be determined by the IPWEA Board and could take into account the following aspects. State briefly but concisely the following:
Active involvement with the Division
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Outstanding and continuing contribution to the industry of public works and services
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Outstanding and continuing contribution to your particular discipline
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Participation in IPWEA continuing professional development programs
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I hereby apply for Fellow Membership of IPWEA Aotearoa/New Zealand Division and confirm that the information I have provided is true. I further agree to abide by the Constitution and Rules of the Institute of Public Works Engineering Australasia Ltd. Signature:
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Date
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Day
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Month
Year
Date
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