Associate, Corporate, Fellow & Technician Membership Application Form

Complete the Form below. All fields marked with * are mandatory. Have your ID, Qualifications and Statement of Experience (A detailed write up on projects you have undertaken signed by Corroborators (superiors you worked under) ready and in soft copy for attachment to this application. Kindly format your attachments to reduce size so that they upload faster. Recommended size of each attachment should be 500KB and not more than 1MB. Permitted file formats are : PDF PNG JPG DOC JPEG TIFF

Personal Details

Title*

First Names*

Surname*

Date of Birth*

ID Number*

Sex*

Place of Birth*

Country of Birth*

Contact Details

Street Address 1*

Street Address 2*

Town / City*

Country*

Email*

Alternative Email

Contact Phone 1*

Contact Phone 2

Whatsapp Number

Membership Details

Membership Required*

Type of Qualification 1*

Educational Qualification 1*

Academic Institution*

Date Obtained

Type of Qualification 2

Educational Qualification 2

Academic Institution

Date Obtained

Type of Qualification 3

Educational Qualification 3

Academic Institution

Date Obtained

Employment Details

Current Employer

Position Held

Date Engaged*

Previous Employer 1

Position Held

From Date

To Date

Previous Employer 2

Position Held

From Date

To Date

Other & Attachments

Which Other Professional Institute are you a Member?

Class of Membership

Date of Election

List Name of Proposer & Name of Seconder (ZIRUP Members) who recommend you for membership & their contacts*

Attach ID*

Attach Qualification 1*

Attach Qualification 2

Attach Qualification 3

CORROBORATORS*

Attach Statement of Experience*

Separator

I hereby undertake that if I am elected, I will abide by the constitution, by-laws and Code of Professional Conduct of the Institute and I will promote the interests of the Institute so far as I am able. I further undertake to pay all subscriptions as may be due to the Institute in respect of the class which I may be elected.

I declare that all particulars given in this application and Statement of experience are true to the best of my knowledge.

Signed at*

Signature*