MEM FO 01 Page 1 of 2
Please affix
one passport
THE INSTITUTION OF ENGINEERS, SRI LANKA size recently
120/15, Wijerama Mawatha, Colombo 7, Sri Lanka. taken colour
Website: [Link] photograph
MEMBERSHIP APPLICATION FORM
CLASS OF MEMBERSHIP APPLIED FOR [Please tick ( X ) the appropriate cage]:
Student Member Associate Companion Affiliate Member Associate Member
Member Fellow Eng. Discipline (Field):
..
[Disciplines: Agricultural/ Building Services/Chemical/Civil/Computer &IT/Electrical, Electronic and Telecommunication/ Marine/
Materials and Metallurgical/Mechanical/Manufacturing/ Mining and Earth Resources / Textile / Other (Please specify) ]
PRESENT CLASS OF MEMBERSHIP AND MEMBERSHIP NUMBER IF ANY [Please tick ( x ) the appropriate cage]:
Student Member Associate Companion Affiliate Member Associate member Member
Membership Number: .
1. APPLICANT'S PERSONAL INFORMATION
Name with initials: Names denoted by initials:
Date of birth ([Link]): Gender (Male/Female): Title: (Mr/Mrs/Miss/Ms/Prof/Dr/Other)
Home Address: Contact Address for communication if different from the home address :
Province:
Office Address:
Telephone : Mobile: Home: Office:
Fax: Home: Office:
E-Mail address: National Identity Card Number: Passport Number:
2. ACADEMIC QUALIFICATIONS STATED IN CHRONOLOGICAL ORDER WITH RESPECT TO THE YEAR OF AWARD
(BOTH SECONDARY AND TERTIARY)
Period of Study Type of Institution
(School/ Technical
Name of the Institution Qualification Awarded Year of Award
College/ University
From To /Other -specify)
Issue/Revision No: 1 Approved by: Executive Secretary Date: 2013.02.18
MEM FO 01 Page 2 of 2
3. PROPOSERS
At least two of the proposers should know the applicant sufficiently to certify, by initialing, that the information provided by the
applicant about his training and experience if any is correct.
All proposers have to be Corporate Members of the Institution who are not in arrears of subscription fees.
For election as a Student Member, Affiliate Member, Associate or an Associate Member: Only two proposers are required.
For transfer/election as a Member or Companion: Four proposers are required and at least one of them will have to be
from the same discipline as the applicant.
For transfer/election as a Fellow: Four proposers are required and at least two of them will have to be Fellows of the
Institution. At least one of the proposers will have to be from the same discipline as the applicant.
[A Corporate M em ber can be either a M em ber or a Fellow of the Institute]
We, the undersigned, propose .. (State the name of the applicant)
from personal knowledge as a person worthy of consideration for admission to the class of
(State the class of membership) of the Institution.
Proposers Name with initials Class of membership Membership No. Signature and Date
4. STATETMENT OF TRAINING AND EXPERIENCE (STATED IN CHRONOLOGICAL ORDER)
(Not required for applicants seeking transfer/election to the class of Student /Affiliate / Associate Member)
Initial of
Period
two of the
From To in Place of work Position held Concise description of work carried out
proposers
months
5. MEMBERSHIP OF OTHER PROFESSIONAL ENGINEERING INSTITUTIONS
6. DECLARATION
I (NAME OF THE APPLICANT) the undersigned, certify that the
information provided above by me is true and that, in the event of my admission as a member of the Institution of Engineers,
Sri Lanka will be governed by the By-laws, regulations and rules of the Institution as they now are, or as they may hereafter be
altered; and that I will advance the objects of the Institution as far as shall be in my power.
Provided that , whenever I shall signify in writing to the Executive Secretary of the Institution that I am desirous of withdrawing
of the membership at the Institution, I shall , after the payment of my arrears which may be due from me at that time , be free
from this obligation.
Signature of Applicant: . Date: .
Notes:
The onus of providing sufficient information for a proper assessment of the application will rest with the applicant. All applicants must send
with this form, evidence of their academic qualifications, training and experience if any. Authenticated photocopies of relevant documentary
evidence will be accepted. See the subscription payment details in MEM-GL-04.
Applicants for admission to the class of Fellow are requested to refer the relevant guidelines and familiarize themselves with the additional
documentation that needs to be submitted with this application form.
Applicants for the class of Member are required to face a Professional Review and are requested to refer to the currently applicable
Professional Review Rules where the eligibility requirements and submissions required are detailed out.
Applicants (who are corporate members of other Engineering Institutions recognized by the IESL) seeking admission to the Class of
Member are required to forward along with this application, a type written report of approximately 2000 words in triplicate giving in detail
an up to date and complete record of his /her training/experience in chronological order.
Please visit IESL website [Link] frequently, to find updated information.
Issue/Revision No: 1 Approved by: Executive Secretary Date: 2013.02.18
