ZIMBABWE INSTITUTION OF ENGINEERS

Conquenar House

P O Box 660

256 Samora Machel Avenue East

Harare

Eastlea,

Page | 1

ZIMBABWE

HARARE

Tel: 746821/746652

Email: zie@zie.co.zw; wilson@zie.co.zw

APPLICATION FOR STUDENT MEMBERSHIP

SECTION 1 (to be completed by the applicant in capitals)
Surname
Date of Birth
First name(s)
National ID No.
Citizenship
Tel. No. (H)
Cell No
Fax No.
Postal Address
E-mail Address
SECONDARY EDUCATION
Educational Institution
attended

From

TECHNICAL/ENGINEERING EDUCATION
Educational Institution
From
attended

To

To

Examinations passed

Degree, Diploma or Certificate to be

obtained

Engineering Discipline
*If elected I would also like to be a member of the following specialist division(s).
(Please indicate with an X in the appropriate box)
YES
AGRICULTURAL DIVISION
BUILDING SERVICES
COMPUTER ENGINEERING
ENERGY
ENVIRONMENT
GEOTECHNICAL

NO
INDUSRTIAL & MANUFACTURING
LARGE DAMS DIVISION
MINING & METARLLURGY
STRUCTURAL DIVISION
WATER & SANITATION
Other (Specify)

Signature of Applicant ...................................... Date..

............................
SECTION 2 (To be completed by the applicants sponsor, a Corporate Member of ZIE)
Name of Sponsor: .......................................................................................
Grade of Membership: ........................................................................................
I am pleased to confirm that the above applicant is currently studying at

and that all above details are correct. I hereby support his/her
application for Student Membership of the Institution.
Signature:............................................. Date: ...................................
For Official Use Only - DETAILS OF PAYMENT:
Cash/Cheque/Money Order No........................... for $.....................
Breakdown: Registration Fee
$.....................
Division
$.....................