(A Division of the Nigerian Society of Engineers)
National Headquarters: 10, Damaturu Close,
( Opp . H -M edi x b y D o min o ’s P iz za , 3 r d A v e nue) , G war inp a, F CT , Abuj a, Ni ger ia
E- M ai l :
[email protected] . W e bsi te : www.nimeche.org
A c c o u nt d et ai l s: F irst B a n k A c ct . 2 0 2 3 8 2 8 31 9
Ap p licatio n for M ember ship
STUDENT
STATE DATE OF ADMISSION:
YEAR MONTH
E-MAIL ADDRESS: TELEPHONE NO(S):
1. NAME:……………………………………………………………………………………………...............................
SURNAME (IN CAPITAL) (OTHER NAMES)
2. HOME ADDRESS: ………………………………………………………………………………...............................
3. POSTAL ADDRESS: ……………………………………………………………………….......................................
4. DATE OF BIRTH: ……………………………………………………………………………………………………….
5. PLACE OF BIRTH: ……………………………………………………………………………..................................
6. NATIONALITY: ………………………………………………………………………………...................................
7. FIELD OF ENGINEERING: …………………………………………………………………………………………….
8. DETAILS OF SECONDARY EDUCATION (Including Dates): ……………………………………......................
…………………………………………………………………………………………………………………………..
9. ACADEMIC QUALIFICATIONS (Attach Photostat of Certificate):
…………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………..
10. MEMBERSHIP OF OTHER PROFESSIONAL INSTITUTIONS / SOCIETIES (If Any):
…………………………………………………………………………………………………………………………..
…………………………………………………………………………………………………………………………..
11. DISTINCTIONS / AWARDS (If Any):
…………………………………………………………………………………………………………………………..
12. TO BE ENDORSED BY HEAD OF DEPARTMENT OF INSTITUTION
I, Engr., Prof., Dr., Mr. ………………………………………………………………………………… Certify that
………………………………………………………………………………...is a student in the Department of
………………………………………………….. Engineering of this University / Institution.
…………………………………………………………………
Signature of Head of Department and Stamp
DECLARATION:
I, ……………………………………………………………………………. agree with the aims and objects of the
Institution and will abide by its Memorandum and Articles of Association.
I also promise that, in the event of my admission, I will be governed by the Memorandum and Articles of
Association of the Institution for the time being in force, and its code of ethics and that I will accept as
final and binding, the decision 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 Institution by presenting papers and discussion and attending the
meetings of the Institution 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.
FOR OFFICE USE ONLY
Date of Receipt of Application:………………………………………………………………………………….............
Recommendation of Membership Committee:……………………………………………………………………….
Chairman:……………………………………………………………….Date:……………………………………………..
Grade of Membership:……………………………………………………………………………………………………..
Number in Registration:………………………………………………………………………………………....................
