AeSSA: Conference registration 2019

To be used by all applicants, including existing members wishing to upgrade or apply with ECSA (RSA) and/or EC (UK) registration. For Student Affiliate grade, use the Student Affiliate application form. All fields marked with * must be completed.

Existing membership number*

If you are an existing member, please supply your membership number, otherwise enter New.

Existing grade

Select your existing grade if applicable.

Grade being applied for*

Select the grade you wish to apply for.

Title / Rank*

Your title or rank. E.g. Mr, Mrs, Miss, Ms ...

First name*

Surname*

Date of Birth*

Gender

Email address*

E.g. example@example.com

Mobile number*

E.g. +27(0)681234567

Postal address for the monthly magazine*

Street Address

Street Address Line 2

CityState / Province

CodeCountry

Job title / designation*

Enter your job title or designation.

Employer*

Name and location of your present employer.

Qualifications*

Please give the FULL name of the College or University, the level (e.g. BSc Hons), the EXACT title of your academic or professional qualification and the course start and end dates. In addition, give title of any licences held, e.g. Pilot or Engineer, number of flying hours or logbook hours. Alternatively, type in "See attached file" and use the "Supporting Documents" button below to attach a document containing this information.

Employment details*

Please supply the information outlined in the block below EITHER by typing in the blocks provided OR by attaching your CV or any other supporting document, provided this contains the information requested. If the latter, please type in “See attached file” in this block.

Supporting documents

Browse Files

Files types allowed are pdf, doc, docx, txt, zip, jpg, jpeg, png, and gif.

Referees

Referee 1*

Name and title.

Job title and employer*

The job title and employer of Referee 1.

Email address or contact number*

The email address or contact number of Referee 1.

Number of years known to you*

How many years have you known Referee 1.

Professional status

Professional membership and number of Referee 1 or enter NA if not applicable.

Referee 2*

Name and title.

Job title and employer*

The job title and employer of Referee 2.

Email address or contact number*

The email address or contact number of Referee 2.

Number of years known to you*

How many years have you known Referee 2.

Professional status

Professional membership and number of Referee 2 or enter NA if not applicable.

Engineering Council (UK) registration

If you are registered with EC-UK, please provide the information listed below. See the guidance sheet for the additional information required for registration as EngTech, IEng or CEng.

Grade

EC registration number

Institution

Institution registered with in UK.

Engineering Council of South Africa registration

If you are registered with the Engineering Council of South Africa (ECSA), please select your Professional status and enter your registration number.

ECSA status

ECSA registration number

Applicant's declaration*

By submitting this application I certify the information contained in this form and any accompanying documentation is correct. I agree that in the event of my election to any class of membership of the Society and, if appropriate, to the ECUK Register of Professional Engineers, or the ECSA Register of Professional Engineers, Technologists, Technicians, I will be bound by the Society’s Charter, By-Laws and Code of Professional Conduct and will further the objectives of the Society as far as shall be within my power during such time as I remain a member. I accept the Society reserves the right to terminate my membership if any of the information in this form and any accompanying documentation are found to be false.