APPLICATION FORM
for MEMBERSHIP of the
INSTITUTE OF GEOLOGISTS OF IRELAND
This form is to be used for applications for all classes of membership. Please read the
accompanying Application Guidelines before you complete this form.
A: PERSONAL DETAILS
Title:
Surname:
Forename (s):
Date of Birth:
Place of Birth:
Nationality / Citizenship:
Current IGI Membership Class:
Class of Membership applied for:
Qualifications:
Business Address:
Please attach a
recent photograph
here.
Home Address:
Telephone:
Telephone:
Fax:
Fax:
e-mail:
e-mail:
I
my IGI Application Fee of:
enclose:
my IGI Annual Subscription of:
my EurGeol. Application Fee (PGeo applicants only) of:
my EurGeol. Annual Subscription (PGeo applicants only) of:
Total:
Signature:
Date:
€
€
€
€
0.00
B: SPONSOR(S)
NAME (Block Capitals)
SIGNATURE
MEMBERSHIP
CLASS & NO.
1.
2.
3.
DECLARATION BY SPONSOR
I consider that the applicant meets the standards required by the Institute of Geologists of
Ireland of a Member-in-Training / Associate Member*:
(* delete as appropriate)
Signature:
IGI Form 4. Revised 10.1.01, Printed 17/4/20
2
C: FIELDS OF PROFESSIONAL EXPERTISE IN GEOLOGY
Rank main field
(1, 2 , max. 3)
1
Main Field
Specialist areas
Geochemistry
Applied Geochemistry
Pure Geochemistry
Geochemical Analysis
Environmental Geochemistry
Other specialist areas(specify)
2
Main Field
Specialist areas
Education
Teaching
Geological Information
History of Geology
Other specialist areas(specify)
3
Main Field
Specialist areas
Engineering Geology & Geotechnics
Geotechnical Engineering
Rock Mechanics
Other specialist areas(specify)
4
Main Field
Specialist areas
Environmental Geology
Contaminated Land
Urban Geology
Waste Management
Environmental Impact Assessment
Environmental Site Assessment & Auditing
Hazardous Waste
Land Reclamation
Geological Hazard Potential
Other specialist areas(specify)
5
Main Field
Specialist areas
Geophysics
Remote Sensing
Seismology
Engineering & Environmental
Mineral Exploration
Hydrocarbon Exploration
Archaeogeophysics
Other specialist areas(specify)
6
Main Field
Specialist areas
Hydrogeology
Water Resources
Groundwater Protection
Other specialist areas(specify)
7
Main Field
Specialist areas
Mining Geology & Exploration
Economic Geology
Appraisal/Evaluation
Exploration
Investment Analysis
Metallic Minerals
Metallurgy
Mine Geology
Other specialist areas(specify)
8
Main Field
Specialist area
Other specialist areas(specify)
Marine Geology
Sedimentology
IGI Form 4. Revised 25th January 2001, Printed 17/4/20
Years
experience
Sponsor’s
initials
3
Rank main field
(1, 2 , max. 3)
9
Main Field
Specialist areas
Hydrocarbon Geology
Seismic Interpretation
Exploration
Development
Production
Natural Gas
Other specialist areas(specify)
10
Main Field
Specialist areas
Palaeontology
Biostratigraphy
Micropalaeontology
Palynology
Maturation
Other specialist areas(specify)
11
Main Field
Specialist areas
Quaternary Geology
Geomorphology
Aerial Photo Interpretation
Soil Science
Quaternary Mapping
Other specialist areas(specify)
12
Main Field
Specialist areas
Geology
Borehole Logging
Geological Mapping
Karstic Geology
Mineralogy
Petrology
Sedimentology
Structural Geology
Stratigraphy
Tectonics
Volcanic Geology
Mathematical Geology
Regional Geology
Metamorphic Geology
Igneous Geology
Heritage
Other specialist areas(specify)
13
Main Field
Specialist areas
Industrial Rocks and Minerals
Aggregates
Coal
Phosphates
Uranium
Clays
Gypsum
Other specialist areas(specify)
14
Main Field
Specialist areas
Management
Operations/Development
Regulatory
Other specialist areas(specify)
15
Main Field
Specialist areas
Geological Computing
GIS
Modelling
Database Management
Other specialist areas(specify)
IGI Form 4. Revised 25th January 2001, Printed 17/4/20
Years
experience
Sponsor’s
initials
4
D: ACADEMIC QUALIFICATIONS (Authenticated copies of degree and/or diploma
certificate(s) must be included with this application)
AWARD SUBJECT
YEAR
AWARDING BODY
PLACE OF
Sponsor’s
STUDY
Initials
E: PUBLICATIONS (Continue on additional sheets if required)
Sponsor’s
Initials
F: CONTINUING PROFESSIONAL DEVELOPMENT PROGRAMMES
Sponsor’s
Initials
IGI Form 4. Revised 25th January 2001, Printed 17/4/20
5
G: MEMBERSHIP OF OTHER BODIES (Professional and/or Scientific)
Name of Organization
Class
Year
Elected
Sponsor’s
Initials
H: OTHER INFORMATION
Sponsor’s
Initials
I: PREVIOUS OCCUPATIONS
List in chronological order, with the employer’s name and address, dates and nature of duties.
Do not include your current occupation as this is covered in the next section. Please include all
periods, whether or not in the geological profession. Continue on additional sheets if necessary.
FROM
TO
EMPLOYER
Applicant’s
Sponsor’s
(Name and address)
Duties
Initials
IGI Form 4. Revised 25th January 2001, Printed 17/4/20
6
J: DETAILS OF PRESENT OCCUPATION and NATURE OF DUTIES
(Brief Description)
K: LIST OF PROFESSIONAL DOCUMENTS
List by number and identifying titles all the Professional Documents submitted in
support of this application. Continue on additional sheets if necessary.
Document Number
Title
DECLARATION
Sponsor’s
Initials
Sponsor’s
Initials
I declare that I am the principal or sole author of the
reports submitted with this application.
SIGNED:
DECLARATION
I declare that I shall abide by the rules of the Institute of Geologists of Ireland.
I shall uphold the highest standards of the Profession as laid out in the Articles of
Association and in the Code of Ethics.
Signed:
Name (BLOCK LETTERS)
Date:
IGI Form 4. Revised 25th January 2001, Printed 17/4/20