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APPLICATION FOR ELECTION OR TRANSFER THIS …

Page | 1 APPLICATION Form 2013 The South African Institute of Electrical Engineers Innes House, 18A Gill Street, Observatory, Johannesburg, 2198 P O Box 751253, Gardenview, 2047 Tel +27-11-487-3003 Fax +27-11-487-3002 Web: Account enquiries: Celeste Pretorius : Membership registrations: Tracey Human: APPLICATION FOR ELECTION OR TRANSFER TO ASSOCIATE/MEMBER/SENIOR MEMBER (Office Use Only) APPLICATION received on: Present Grade: since: Graded by Council as: Date of Meeting: NOTE: THIS FORM MUST BE COMPLETED IN BLOCK LETTERS, SIGNED AND EITHER FAXED BACK TO 011-487-3002 OR SCANNED AND EMAILED TO (Do not return without a signature, requested documents & proof of payment as per page 2) Your Personal Details: Surname: First names: Title: Date of Birth: ID Number: Country of Citizenship: Contact Details: Physical Address.

Page | 1 Application Form 2013 The South African Institute of Electrical Engineers Innes House, 18A Gill Street, Observatory, Johannesburg, 2198

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