<p>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</p><p>APPLICATION FOR INDIVIDUAL MEMBERSHIP</p><p>Title Give Family n Name Nam e Postal Date Address of Birth Phone Numb er Email Primary: Addres s Secondary:</p><p>Academic Qualifications Professional Memberships (Year)</p><p>Present Employ er</p><p>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)</p><p>EXPERIENCE FIELD OF INTEREST in earthquake engineering or related fields in earthquake engineering or related subjects</p><p>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)</p><p>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</p><p>Young Professional Signed Student membership</p><p>Student ID number Date ANNUAL SUBSCRIPTION Due on notification of acceptance for Send no money with Application membership, thereafter on 1 October</p><p>A Collaborating Technical Society of IPENZ Engineers New Zealand, and publishers of the NZSEE Bulletin</p>