Application for Individual Membership

NEW ZEALAND SOCIETY FOR EARTHQUAKE ENGINEERING INC. Executive Officer: Win Clark Phone + 64 4 565 3650 PO Box 2193 Fax + 64 4 565 3650 Wellington WELLINGTON 6140 E-mail: [email protected] NEW ZEALAND Web Site: www.nzsee.org.nz

APPLICATION FOR INDIVIDUAL MEMBERSHIP

Title Give Family n Name Nam e Postal Date Address of Birth Phone Numb er Email Primary: Addres s Secondary:

Academic Qualifications Professional Memberships (Year)

Present Employ er

ENGINEERIN SCIENTIFIC ARCHITECTURE OCCUPATION G Civil Geology please tick appropriate Geotechnica Geophysics INSURANC category l E Structural Seismology Mechanical Applied maths OTHER Other Other (specify) (specify links (specify): to earthquake engineering)

EXPERIENCE FIELD OF INTEREST in earthquake engineering or related fields in earthquake engineering or related subjects

DECLARATION I am applying for : please tick one If admitted to membership, I agree to abide by the rules of the New Zealand Society for Earthquake Full membership Engineering (Inc)

A Collaborating Technical Society of IPENZ Engineers New Zealand, and publishers of the NZSEE Bulletin NEW ZEALAND SOCIETY FOR EARTHQUAKE ENGINEERING INC. Executive Officer: Win Clark Phone + 64 4 565 3650 PO Box 2193 Fax + 64 4 565 3650 Wellington WELLINGTON 6140 E-mail: [email protected] NEW ZEALAND Web Site: www.nzsee.org.nz

Young Professional Signed Student membership

Student ID number Date ANNUAL SUBSCRIPTION Due on notification of acceptance for Send no money with Application membership, thereafter on 1 October

A Collaborating Technical Society of IPENZ Engineers New Zealand, and publishers of the NZSEE Bulletin