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The Nigerian Institution of Electrical and Electronics Engineers A Division of The Nigerian Society of Engineers Membership Application Form & Update Please complete this form, using black ball pen and print clearly or type in capital letters, sign and return to: Vice Chairman, Membership The Nigerian Institution of Electrical and Electronics Engineers, National Secretariat, 1 Engineering Close, NEC, Victoria Island, Lagos.

Vice Chairman, Membership The Nigerian Institution of Electrical and Electronics Engineers P.O.Box 50233, Falomo, Ikoyi, Lagos

Fix Passport photograph here, Print name in capital letters and sign on the back

1. Personal Information Please provide all information requested. Note that incomplete application will not be processed. Please print clearly or type in capital letters only. Underline your surname as Identifier for the NIEEE Database. Abbreviate when needed.

Title

Surname

First Name

NSE Reg. No. / Year of Registration

Middle Name

COREN Reg. No. / Year of Registration

Residential Address

Contact Address (Business)

P. O. BOX ___________________________________________________________________________________

Town

Date of Birth

State

Day

Month

Home Phone

Year

Nationality Sex Female

Post Office Address (P. O. Box)

Please send mails to: Home Address Business Address

Email Address:

Post Office

Male

Preferred NIEEE email address:

2. Educational Information Please give information concerning your educational background and professional degrees .

A Course

University

Date Obtained

Course

University

Date Obtained

Course

University

Date Obtained

B C

_____

3. Business / Professional Information For new applicant, please attach resume of working experience / position held, with date since graduation. State present employment

Company /Name

Area of Specialization

Department / Division

Title / position

Years in present position

BUSINESS ADDRESS

Contact Phone Nos

Business Fax

Email Address NSE Membership Profile

Year of Registration

Student Graduate Corporate Fellow Life Member

4. Business / Professional Information I hereby make application / update membership of The Nigerian Institution of Electrical and Electronics Engineers and agree to be governed by the division bye-law and promise to promote the objective to the best of my ability. All information given herein is accurate

Signature

Date

S/N

DESCRIPTION

1 2 3 4 5 6

Registration Annual Subscription DEEEAL Lecture E-mail reg. & maint. eee+T magazine Byelaw TOTAL

6. 8. 10. Corporate (Old) 12. NIL N5,000 N1,000 N1,000 N1,000 N500 N8,500

5. Enrolment Fees & Annual Subscription 7. 9. Corporate Associate Associate Graduate 11.Graduate (New) (Old) (New) (Old) 13.(New) N5,000 N5,500 N4,500 N5,000 N4,500 14. N5,000 N1,000 N5,000 N1,500 N5,000 N1,000 N1,000 N1,000 N500 N13,500

NIL NIL NIL N500 N7,000

NIL N1,000 N1,000 N500 N12,000

NIL NIL NIL N500 N7,000

NIL N1,000 N1,000 N500 N12,000

Student (Old) N2,000 N500 NIL NIL N500 N500 N3,500

Student (New) N2,000 N500 NIL N1,000 N500 N500 N4,500

Fellow NIL N14,500 NIL NIL NIL N500 N15,000

Life membership cadre is no longer available. However, all existing Life Members are required to pay an annual sum of N3,000 only, covering DEEEAL Lecture, E-mail registration and maintenance and eee+T magazine subscription.

Evidence of payment is required if membership is being updated 6. Payment Method

15. 16. Payment of membership dues can be made by 17. 18.  Bankers Cheque(Bankers Draft) payable to 19. 20. The Nigerian Institution of Electrical and Electronics Engineers 21.of The Institution’s activities to Financial Secretary 22.  Or during any / General Secretary. 23.  Make a cash payment into United Bank for Africa, Idowu Taylor, Account Number: 03420310000014, in favour of “The Nigerian Institution of Electrical and Electronics Engineers”

To contribute and subscribe to the ee+T magazine contact The Editor, ee+T, P.O.Box 50233, Ikoyi, Lagos.

For Office Use Only

24. 26. 28. 33. 30. 35. 37. 39. Official’s Name

25. 27. 7. Enrolment Fees & Annual Subscription 29. 34. 31. 36. Application 32. Received by 38. 40. 41.

Date

Sign

Payment Received by Official’s Name Date

Sign Approval of Application

Approved

Reject

Chairman Name Date Sign

General Secretary Name Date Sign Notification of member

Date posted

Sign

Institution’s Admission No. Database Entry

Date 8. Enrolment Fees & Annual Subscription

Official’s Name Date

42. 44. 46. 48.

43. Form Processed 45. 47. 49. Sign 50. Payment Received by

Financial Secretary’s Name Date

Sign

Database Entry

Date