FORM N.S.E.

NO.

Photograph

NATIONAL ENGINEERING CENTRE

Off National Mosque-Labour House road,
Central Business area,
Abuja, Nigeria.
E-mail: info@nse.org.ng

Website: http://www.nse.org.ng

Application for Membership

GRADUATE

E-MAIL ADDRESSTELEPHONE NO.................................

1. NAME:
(CAPITALS) SURNAME

(OTHER NAMES)

2. HOME ADDRESS:.
.
3. POSTAL ADDRESS:...
4. DATE OF BIRTH:

5. SEX:
D

6. NATIONALITY:.
7. FIELD OF ENGINEERING:.
8. SPECIALISATION:..
9. PRESENT PLACE OF EMPLOYMENT:.
10. POSITION: ..
DATA OF NEXT OF KIN
11. NAME OF NEXT OF KIN:
12. ADDRESS:
..

13. E-MAIL: 14. MOBILE NO..:

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ACADEMIC DATA
15. DETAILS OF SECONDARY EDUCATION (INCLUDE DATES)

16. DETAILS OF UNIVERSITY/TERTIARY INSTITUTIONS ATTENDED (INCLUDE DATES)

S/N

QUALIFICATIONS
OBTAINED

UNIVERSITY/TERTIARY INSTITUTIONS

DATES

(Attach certified photocopies of certificates)

17. MEMBERSHIP OF OTHER PROFESSIONAL INSTITUTIONS/SOCIETIES
S/N

NAMES OF INSTITUTIONS

DATES

(Attach certified photocopies of certificates)

18. OTHER DISTINCTIONS/AWARDS

S/N

DISTINCTIONS/AWARDS

DATES

(Attach certified photocopies of certificates)

19. PROPOSERS
We recommend the application of . in his
desire to become a . of the Society and hereby propose him to the Council.
S/N

NAME IN FULL

GRADE

SIGNATURE

MEMBERSHIP
REG. NO.

DATE

1.
2.
(* Must be Financial Corporate Member of the Society).

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MEMBERSHIP OF BRANCHES AND DIVISIONS

A.

BRANCH

This section must be completed by the chairman of the candidates intended Branch. The application will not be processed further
without these
See lists of Branches on page 4.

1. BRANCH...
2. NAME OF BRANCH CHAIRMAN:...

3. HOW LONG HAVE YOU KNOWN THE CANDIDATE?

4. IS THE CANDIDATE ACTIVE AT THE BRANCH?

YES

NO

5. BRANCH CHAIRMANS SIGNATURE..

B. DIVISION (S)

To be completed by the chairman of one of the intended divisions. See the list of Divisions on page

1. DIVISION:.
2. NAME OF DIVISION CHAIRMAN:...

3. HOW LONG HAVE YOU KNOWN THE CANDIDATE?

4. IS THE CANDIDATE ACTIVE AT THE DIVISION?

YES

NO

5. DIVISION CHAIRMANS SIGNATURE..

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The Branches Are:

1.

ABA

21.

ENUGU

41.

MAKURDI

2.

ABEOKUTA

22.

EGBIN

42.

MINNA

3.

ABAKALIKI

23.

GOMBE

43.

NEW BUSSA

4.

ABUJA

24.

GUSAU

44.

NSUKKA

5.

ADO-EKITI

25.

IBADAN

45.

OMOKU

6.

AJAOKUTA

26.

IKEJA

46.

ONITSHA

7.

AKURE

27.

IKOT-ABASI

47.

OSHOGBO

8.

APAPA

28.

ILE-IFE

48.

OWERRI

9.

ASABA

29.

ILESHA

49.

PORT-HARCOURT

10.

AWKA

30.

ILORIN

50.

SOKOTO

11.

BAUCHI

31.

JALINGO

51.

UMUAHIA

12.

BENIN

32.

JOS

52.

UYO

13.

BIDA

33.

KADUNA

53.

VICTORIA ISLAND

14.

BIRNIN-KEBBI

34.

KANO

54.

WARRI

15.

BONNY

35.

KATSINA

55.

YENAGOA

16.

CALABAR

36.

LAFIA

56.

YOLA

17.

DAMATURU

37.

LAGOS

57.

ZARIA

18.

DUTSE

38.

LOKOJA

19.

EKPOMA

39.

MAIDUGURI

20.

EKET

40.

MAITAMA

The Divisions are:

1.
2.
3.
4.
5.
6.

Aeronautical
Agricultural
Appraisers and Cost Engineers
APWEN
Automotive
Chemical

7.
8.
9.
10.
11.
12.

Civil
Electrical
Environmental
Geotechnical
Industrial
Marine Engineering & Naval
Architecture

13. Mechanical
14. Metallurgical, Materials
& Mining
15. Petroleum
16. Space
17. Structural
18. Water

A member is free to belong to up to 3 Divisions

..

FOR OFFICIAL USE ONLY

(Admission or Transfer)
Date of Application...
Recommendation of Membership Board..
Admission approved by the Council this .. day of ...
Name/Signature of Coordinator................
Name/Signature of Head, Membership Services..
Name/Signature of Chairman, Membership Board..
Number in register
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STATEMENT OF EXPERIENCE AND RESPONSIBILITY

DATE
(FROM - TO)

POSITION, EMPLOYER AND DESCRIPTION OF PROJECT

(WITH COST) E.T.C.

CONFIRMED
BY

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DECLARATION:
I, .. agree with the
aims and objects of the Society and will abide by its Memorandum and Articles.

I also promise that, in the event of my admission, I will be governed by the Memorandum
and Articles of Association of the Society for the time being in force, and its code of ethics
and that I will accept as final and binding the decisions of the executive Council on All
matters dealt with by them in accordance with the provision of the said memorandum and
articles.

I will advance the objects of the Society by presenting papers and discussion and attending
the meetings of the Society as often as possible.

Date Signature of Candidate ..

*NB:
Please attach a photocopy of the receipt for the Purchase of this form. Failure to do this may delay your
application.
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