FORM N.S.E.

Photograph

NO.

NATIONAL ENGINEERING CENTRE

Off National Mosque-Labour House road, Central Business area, Abuja, Nigeria. E-mail: info@nse.org.ng Website: http://www.nse.org.ng

Application for Membership CORPORATE MEMBER

IF YOU ARE A GRADUATE OR STUDENT MEMBER, FILL THE FOLLOWING: GRADUATE NO.:.. STUDENT NO.: E-MAIL ADDRESSTELEPHONE NO................................. 1. NAME:
(CAPITALS) SURNAME (OTHER NAMES)

2. HOME ADDRESS:. . 3. POSTAL ADDRESS:... 4. DATE OF BIRTH:

D D M M Y Y Y Y

5. SEX:

6. NATIONALITY:. 7. FIELD OF ENGINEERING:. 8. SPECIALISATION:.. 9. PRESENT PLACE OF EMPLOYMENT:. 10. POSITION: .. DATA OF NEXT OF KIN 11. NAME OF NEXT OF KIN: 12. ADDRESS: .. 13. E-MAIL: 14. MOBILE NO..:
NSE Corporate Membership Application Form 1/6

ACADEMIC DATA 15. DETAILS OF SECONDARY EDUCATION (INCLUDE DATES)

16. DETAILS OF UNIVERSITY/TERTIARY INSTITUTIONS ATTENDED (INCLUDE DATES) S/N UNIVERSITY/TERTIARY INSTITUTIONS QUALIFICATIONS OBTAINED DATES

(Attach certified photocopies of certificates) 17. MEMBERSHIP OF OTHER PROFESSIONAL INSTITUTIONS/SOCIETIES S/N NAMES OF INSTITUTIONS DATES

(Attach certified photocopies of certificates)

18. OTHER DISTINCTIONS/AWARDS S/N DISTINCTIONS/AWARDS DATES

(Attach certified photocopies of certificates)

19. PROPOSERS We recommend the application of . in his desire to become a . of the Society and hereby propose him to the Council.
S/N NAME IN FULL GRADE SIGNATURE MEMBERSHIP REG. NO. DATE

1. 2.
(* Must be Financial Corporate Member of the Society).
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MEMBERSHIP OF BRANCHES AND DIVISIONS

A. BRANCH

This section must be completed by the chairman of the candidates intended Branch. The application will not be processed fur ther without these See lists of Branches on page 4.

1. BRANCH... 2. NAME OF BRANCH CHAIRMAN:...

3. HOW LONG HAVE YOU KNOWN THE CANDIDATE?

4. IS THE CANDIDATE ACTIVE AT THE BRANCH?

YES

NO

5. BRANCH CHAIRMANS SIGNATURE..

B. DIVISION (S) To be completed by the chairman of one of the intended divisions. See the list of Divisions on page 4

1. DIVISION:. 2. NAME OF DIVISION CHAIRMAN:...

3. HOW LONG HAVE YOU KNOWN THE CANDIDATE?

4. IS THE CANDIDATE ACTIVE AT THE DIVISION?

YES

NO

5. DIVISION CHAIRMANS SIGNATURE..

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The Branches Are:

1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. ABA ABEOKUTA ABAKALIKI ABUJA ADO-EKITI AJAOKUTA AKURE APAPA ASABA AWKA BAUCHI BENIN BIDA BIRNIN-KEBBI BONNY CALABAR DAMATURU DUTSE EKPOMA EKET 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. ENUGU EGBIN GOMBE GUSAU IBADAN IKEJA IKOT-ABASI ILE-IFE ILESHA ILORIN JALINGO JOS KADUNA KANO KATSINA LAFIA LAGOS LOKOJA MAIDUGURI MAITAMA 41. 42. 43. 44. 45. 46. 47. 48. 49. 50. 51. 52. 53. 54. 55. 56. 57. MAKURDI MINNA NEW BUSSA NSUKKA OMOKU ONITSHA OSHOGBO OWERRI PORT-HARCOURT SOKOTO UMUAHIA UYO VICTORIA ISLAND WARRI YENAGOA YOLA ZARIA

The Divisions are:

1. 2. 3. 4. 5. 6. Aeronautical Agricultural Appraisers and Cost Engineers APWEN Automotive Chemical 7. 8. 9. 10. 11. 12. Civil Electrical Environmental Geotechnical Industrial Marine Engineering & Naval Architecture 13. Mechanical 14. Metallurgical, Materials & Mining 15. Petroleum 16. Space 17. Structural 18. Water

A member is free to belong to up to 3 Divisions ..

FOR OFFICIAL USE ONLY

(Admission or Transfer)
Date of Application... Recommendation of Membership Board.. Admission approved by the Council this .. day of ... Name/Signature of Coordinator.. .............. Name/Signature of Head, Membership Services.. Name/Signature of Chairman, Membership Board.. Number in register
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STATEMENT OF EXPERIENCE AND RESPONSIBILITY

DATE (FROM - TO) POSITION, EMPLOYER AND DESCRIPTION OF PROJECT (WITH COST) E.T.C. CONFIRMED BY

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DECLARATION: I, .. agree with the aims and objects of the Society and will abide by its Memorandum and Articles.

I also promise that, in the event of my admission, I will be governed by the Memorandum and Articles of Association of the Society for the time being in force, and its code of ethics and that I will accept as final and binding the decisions of the executive Council on All matters dealt with by them in accordance with the provision of the said memorandum and articles.

I will advance the objects of the Society by presenting papers and discussion and attending the meetings of the Society as often as possible.

Date Signature of Candidate ..

*NB: Please attach a photocopy of the receipt for the Purchase of this form. Failure to do this may delay your application.
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