Please complete all sections of the form.

Once completed, please save a copy and submit this form via email to: membership-
apps@cibse.org AND print and post one copy to: Membership Department, CIBSE, 222 Balham High Road, SW12 9BS, UK.

APPLICATION FOR MEMBER/

FELLOW MEMBERSHIP

Please complete all sections of this application form and ensure
that copies of qualification certificates, signed by your sponsor,
and your CV, Engineering Practice Report, Organisational
Chart, Development Action Plan are attached and the required
payment is included. Please do not bind or staple documents.
APPLICATION FOR MEMBER/FELLOW MEMBERSHIP
Applying for: Member Fellow
Please indicate whether:
New (not previously a member of CIBSE) or,
Transfer (already CIBSE member)
Membership Number Grade
Have you previously applied to join CIBSE? (state Y/N in the box)
Please tick if already Interim registered
Please provide registration number and the Institution through
which you are registered:
PERSONAL DETAILS
REASON FOR JOINING
What prompted you to submit this application? Select ONE only:
Received a CIBSE mailing/Email/Newsletter
Advised by colleague/employer/CIBSE member
Attended a CIBSE membership briefing session
Found information on CIBSE website
Attended a CIBSE event/exhibition
Saw article/advert in industry publication
Saw information on Twitter/Linkedin
Other (please specify)
EMPLOYMENT DETAILS
Please submit your curriculum vitae, in chronological order,
providing full details of your work experience within the field of
building services engineering. This must include dates, full details
of the companies you have worked for, the posts you have held,
and level of responsibility.
ENGINEERING PRACTICE REPORT

Title Select First Name(s) Please submit an Engineering Practice Report (EPR) of
between 4000 to 5000 words. Your Report should be based on
Surname the Competence Criteria for MCIBSE or FCIBSE(fact sheet M21/
Date of Birth D D / M M / Y Y F21). For advice on how to write an EPR please refer to the
Application Guidance for MCIBSE or FCIBSE (fact sheet M20/F20)
Home address
and review exemplar reports at www.cibse.org/applicanthelp

ORGANISATIONAL CHART
Post code
Country Please submit an organisational chart indicating your position
in the organisation.
Telephone No
Fax No DEVELOPMENT ACTION PLAN

Email Please submit a statement of how you intend to continue with

your personal and professional development, stating your short,
Mobile No medium and long term goals and your intended actions to attain
Company name those goals. See fact sheet M20/F20.
Work address MAIN ENGINEERING DISCIPLINE
Please indicate from the list below your main area of expertise
Post code in building services engineering. This information will assist CIBSE
Country in allocating an appropriate assessor to appraise your application.
Telephone No Academia Electrical
Fax No Energy Management Environmental
Email Facilities Management M & E
Preferred mailing address Home Work Mechanical Public Health
Preferred email address Home Work Other (please specify)

APPLICATION FOR MEMBER/FELLOW MEMBERSHIP Page 1 of 4

 SPONSORS DECLARATION
Please provide one sponsor, who should be a professionally qualified Date of Birth D D / M M / Y Y
Member (MCIBSE) or Fellow (FCIBSE) of CIBSE, a CEng registrant
Signature Date
with any Engineering Council nominated institution or professionally
DD / MM / YY
registered within the construction industry. Your sponsor should have
known you for a minimum of one year. For further details of the role
of the sponsor please see the Application Guidance for MCIBSE or
FCIBSE (fact sheet M20/F20). NB. Sponsors may be contacted by Sponsors Institution Membership (if applicable):
CIBSE for confirmation of their support of the applicant. Name of Institution:
To the best of my knowledge, all the information contained CIBSE membership No (if applicable)
in this application and supporting documents is correct.
EngC registration grade/registration number
I confirm my support for this application at the grade applied *If you are professionally registered with a non-Engineering Council nominated
for and have known the applicant for years. I consider institution, please send a copy of your registration certificate with this application.
that the candidate is competent in the A-E criteria and I have
INTERVIEW LOCATION
carefully read the sponsor guidance in the factsheet M20/F20.
Please tick your preferred interview location and we will take this
I confirm that I am:
into account when arranging your interview.
Professionally qualified CIBSE member
North West South West
CEng registrant
London and South East North East
Professionally registered within the construction industry*
Scotland East Midlands
Name of sponsor West Midlands Yorkshire
Home address Wales Northern Ireland
Republic of Ireland Hong Kong
Post code Australia United Arab Emirates
Country
Qatar New Zealand
Telephone No If you have any special requirements please let us know
Email

DEMONSTRATION OF COMPETENCIES (MCIBSE/FCIBSE/CEng) TO BE COMPLETED BY THE SPONSOR

Please indicate below how the applicant has demonstrated, through your experience, the levels of competence required, as set in the
UK-SPEC, relative to the grade of membership and/or registration for which the applicant is applying.
A Use a combination of general and specialist engineering knowledge and understanding to optimise the application
of existing and emerging technology

B Apply appropriate theoretical and practical methods to the analysis and solution of engineering problems

APPLICATION FOR MEMBER/FELLOW MEMBERSHIP Page 2 of 4

 DEMONSTRATION OF COMPETENCIES (MCIBSE/FCIBSE/CEng) TO BE COMPLETED BY THE SPONSOR (CONTINUED)

C Provide technical and commercial leadership

D Demonstrate effective interpersonal skills

E Demonstrate a personal commitment to professional standards, recognising obligations to society, the profession and
the environment

EDUCATIONAL QUALIFICATIONS
Please list all your post school qualifications below and indicate any exemptions granted and details of any interruptions to your course.
Awards shown must be accompanied by a photocopy of the original certificate countersigned by your Sponsor as having seen the original.
University or Full title of qualifications Date course Course Date Mode of Study Year of entry
College gained including commenced duration qualification (F/T, P/T, sandwich, to course
etc.) (i.e entered in year 1 or
subject area obtained
2, 3 due to exemptions)

APPLICANTS DECLARATION

I certify that the information in this application and supporting I shall, after payment of any arrears which may be due by me
documents are correct. I agree that, in the event of my election at that period, be free from this obligation.
to any class of membership of the Chartered Institution of Building
Signature Date
Services Engineers, I will be governed by the provisions of the
DD / MM / YY
Royal Charter and By-laws as they are now formed or as they
may be hereafter altered; that I agree to abide by the Code of
Professional Conduct, which can be found at www.cibse.org/code,
and do all in my power to advance the objects of the Institution;
NB. In the event of it coming to light that information supplied on this form is inaccurate,
providing that whenever I shall signify in writing to the Director CIBSE reserve the right to withdraw membership of the Institution and discipline the
of Membership that I wish to withdraw from the Institution, applicant under the Code of Professional Conduct.

APPLICATION FOR MEMBER/FELLOW MEMBERSHIP Page 3 of 4

 FEES

Please visit www.cibse.org/fees for details of all subscription, Payment can be made by cheque payable to CIBSE or by completing
application, interview and Engineering Council fees. the debit/credit card details below:
All applicants must include payment for the following: Please tick:
Application fee (if not already a CIBSE Member) Mastercard Visa Visa/Delta Maestro
Interview fee
Annual Subscription fee for MCIBSE / FCIBSE Please note: we do not accept Amex or laser cards
Engineering council CEng registration fee (if applicable) Card Number
All subscription fees run on an annual basis from 1st January to 31st December each
year. If you have already paid the annual subscription for another grade, the difference Valid from M M / Y Y Expiry Date M M / Y Y
between this rate and the new grade rate is payable when your membership is confirmed.
Fees are not dependent on date of joining and therefore not prorated. All application fees Issue Number (For Maestro only) Security Code
are non refundable.
Address details card is registered to
Credit Card Payers
Your application and interview fee will be debited
on receipt of your application. Post code
Your subscription fee and engineering council fees
Country
(if applicable) will be debited when your application
has been approved. Please debit card to the amount of
Signature of Cardholder Date
DD / MM / YY

DATA PROTECTION SUBMITTING YOUR APPLICATION:

The information you provide in this application form will be Please post one hard copy and one email copy of your
used by CIBSE and its regions or administrative agents for application and supporting documents.
administrative and membership purposes or as required by PLEASE POST ONE COPY OF YOUR APPLICATION TO:
law. We will use your information to keep you up to date with Membership Department
news and developments in the industry, via email and post. Chartered Institution of Building Services Engineers
We do not sell lists of our members, but may pass your details on 222 Balham High Road, London, SW12 9BS, UK
to CIBSE regions acting on CIBSEs behalf as well as third parties AND PLEASE EMAIL ONE COPY OF YOUR APPLICATION TO:
who work with CIBSE closely. If you do not wish to receive membership-apps@cibse.org
mailings or emails from CIBSE please opt out below:
Telephone +44 (0)20 8772 3650 | Fax +44 (0)20 8675 5449
I do not wish to receive mailings from CIBSE
Registered Charity No. 278104
I do not wish to receive emails from CIBSE
I do not wish to receive mailings (including emails) from CIBSE HQ USE ONLY:
third parties approved by CIBSE relating to products and
services that are relevant to my membership.
CIBSE seeks to provide the best possible support to candidates.
From time to time, we use applicants material to illustrate
best practice. All material is anonymised. If you do not wish
your application to be used for this purpose, please tick here

APPLICATION FOR MEMBER/FELLOW MEMBERSHIP Page 4 of 4