NEW ZEALAND SOCIETY FOR EARTHQUAKE ENGINEERING INC.

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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: [email protected]
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
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