AHSCA (Victorian Chapter) - Membership Application Online

Design Membership Application Form (VIC Chapter)

Please complete the following details to assist the application review process.
Applicant Name

First NameLast Name
Email
example@example.com
Mobile Number
Please enter a valid mobile number (04XX XXX XXX)Format: 0000 000 000.
Phone Number
Please enter a valid landline phone number with area code.Format: (00) 0000 0000.
Contact Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Education and Qualifications

Please provide further details on your tertiary education and professional qualifications.
Name and Level of Tertiary Education
(Bachelor of Engineering, Advanced Diploma, Diploma of Hydraulic Services Design, Certificate IV, etc)
Professional Registrations

Other
- Name and Level of Tertiary Education
  (Bachelor of Engineering, Advanced Diploma, Diploma of Hydraulic Services Design, Certificate IV, etc)

Additional Supporting Documentation

Please supply relevant references and additional documentation to verify and demonstrate your project and hydraulic services design experience noted above. The AHSCA (Victorian Chapter) Board and Committee may request further information following the application submission.
Please provide supporting documentation including a CV detailing your professional credentials and experience. If you'd like to include any additional work and project experience not outlined previously, please include this information within the attachments.

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- Referee Name
  
  First NameLast Name
- Referee Applicable Firm
- Referee Email
  example@example.com
- Referee Mobile Number
  Please enter a valid mobile number (04XX XXX XXX)Format: 0000 000 000.
- Referee Phone Number
  Please enter a valid landline phone number with area code.Format: (00) 0000 0000.
- Referee Name
  
  First NameLast Name
- Referee Applicable Firm
- Referee Email
  example@example.com
- Referee Mobile Number
  Please enter a valid mobile number (04XX XXX XXX)Format: 0000 000 000.
- Referee Phone Number
  Please enter a valid landline phone number with area code.Format: (00) 0000 0000.

Application Submission

Please confirm the below to finalise your AHSCA (Victorian Chapter) membership application. Once submitted, the AHSCA (VIC) Board and Committee will review your application and confirm the results of your application.
Nominating current AHSCA(VIC) member

First NameLast Name
Nominating member Contact Email
Please provide email of nominating AHSCA (VIC) member
Nominating member Contact Number

Area CodePhone Number
By submitting the application, I confirm that the information provided is true and accurate. I understand and agree that I may be contacted by the AHSCA (Victorian Chapter) Board and Committee for additional information regarding the application. This includes contacting the referees noted in the application for verification purposes. I have read the AHSCA (VIC) Code of Ethics & Professional Practice, and agree to abide by them, including the Rules of the Association at all times should my application be successful.
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Design Membership Application Form (VIC Chapter)