NEW ZEALAND SOCIETY FOR EARTHQUAKE ENGINEERING INC. Executive Officer: Win Clark PO Box 2193 Wellington WELLINGTON 6140 NEW ZEALAND Phone + 64 4 565 3650 Fax + 64 4 565 3650 E-mail: exec@nzsee.org.nz Web Site: www.nzsee.org.nz APPLICATION FOR INDIVIDUAL MEMBERSHIP Title Given Name Family Name Date of Birth Phone Number Email Address Postal Address Academic Qualifications Professional Memberships (Year) Present Employer ENGINEERING Civil SCIENTIFIC Geology Architecture OCCUPATION Geotechnical Structural Mechanical Other (specify): Geophysics Seismology Applied maths Other (specify) Insurance please tick appropriate category EXPERIENCE in earthquake engineering or related fields Other (specify links to earthquake engineering) FIELD OF INTEREST in earthquake engineering or related subjects DECLARATION If admitted to membership, I agree to abide by the rules of the New Zealand Society for Earthquake Engineering (Inc) ANNUAL SUBSCRIPTION Due on notification of acceptance for membership, thereafter on 1 October I am applying for Full membership I am applying for Student membership Student ID number Signed Date please tick one Send no money with Application A Collaborating Technical Society of IPENZ Engineers New Zealand, and publishers of the NZSEE Bulletin