6

APPLICATION FORM

for MEMBERSHIP of the

INSTITUTE OF GEOLOGISTS OF IRELAND

This form is to be used for applications for all classes of membership. Please read the accompanying Application Guidelines before you complete this form.

A: PERSONAL DETAILS
Title: / Surname: / Please attach a
Forename (s): / recent photograph
Date of Birth: / Place of Birth: / here.
Nationality / Citizenship:
Current IGI Membership Class:
Class of Membership applied for:
Qualifications:
Business Address: / Home Address:
Telephone: / Telephone:
Fax: / Fax:
e-mail: / e-mail:
I enclose: / my IGI Application Fee of: / €
my IGI Annual Subscription of: / €
my EurGeol. Application Fee (PGeo applicants only) of: / € 0.00
my EurGeol. Annual Subscription (PGeo applicants only) of: / €
Total:
Signature: / Date:

B: SPONSOR(S)

NAME (Block Capitals) /

SIGNATURE

/ MEMBERSHIP CLASS & NO.
1.
2.
3.
DECLARATION BY SPONSOR
I consider that the applicant meets the standards required by the Institute of Geologists of Ireland of a Member-in-Training / Associate Member*:
(* delete as appropriate)
Signature:


C: FIELDS OF PROFESSIONAL EXPERTISE IN GEOLOGY

Rank main field (1, 2 , max. 3) / Years
experience / Sponsor’s
initials
1 / Main Field / Geochemistry
Specialist areas / Applied Geochemistry
Pure Geochemistry
Geochemical Analysis
Environmental Geochemistry
Other specialist areas(specify)
2 / Main Field / Education
Specialist areas / Teaching
Geological Information
History of Geology
Other specialist areas(specify)
3 / Main Field / Engineering Geology & Geotechnics
Specialist areas / Geotechnical Engineering
Rock Mechanics
Other specialist areas(specify)
4 / Main Field / Environmental Geology
Specialist areas / Contaminated Land
Urban Geology
Waste Management
Environmental Impact Assessment
Environmental Site Assessment & Auditing
Hazardous Waste
Land Reclamation
Geological Hazard Potential
Other specialist areas(specify)
5 / Main Field / Geophysics
Specialist areas / Remote Sensing
Seismology
Engineering & Environmental
Mineral Exploration
Hydrocarbon Exploration
Archaeogeophysics
Other specialist areas(specify)
6 / Main Field / Hydrogeology
Specialist areas / Water Resources
Groundwater Protection
Other specialist areas(specify)
7 / Main Field / Mining Geology & Exploration
Specialist areas / Economic Geology
Appraisal/Evaluation
Exploration
Investment Analysis
Metallic Minerals
Metallurgy
Mine Geology
Other specialist areas(specify)
8 / Main Field / Marine Geology
Specialist area / Sedimentology
Other specialist areas(specify)
Rank main field (1, 2 , max. 3) / Years
experience / Sponsor’s
initials
9 / Main Field / Hydrocarbon Geology
Specialist areas / Seismic Interpretation
Exploration
Development
Production
Natural Gas
Other specialist areas(specify)
10 / Main Field / Palaeontology
Specialist areas / Biostratigraphy
Micropalaeontology
Palynology
Maturation
Other specialist areas(specify)
11 / Main Field / Quaternary Geology
Specialist areas / Geomorphology
Aerial Photo Interpretation

Soil Science

Quaternary Mapping
Other specialist areas(specify)
12 / Main Field / Geology
Specialist areas / Borehole Logging
Geological Mapping
Karstic Geology
Mineralogy
Petrology
Sedimentology
Structural Geology
Stratigraphy
Tectonics
Volcanic Geology
Mathematical Geology
Regional Geology
Metamorphic Geology
Igneous Geology
Heritage
Other specialist areas(specify)
13 / Main Field / Industrial Rocks and Minerals
Specialist areas / Aggregates
Coal
Phosphates
Uranium
Clays
Gypsum
Other specialist areas(specify)
14 / Main Field / Management
Specialist areas / Operations/Development
Regulatory
Other specialist areas(specify)
15 / Main Field / Geological Computing
Specialist areas / GIS
Modelling
Database Management
Other specialist areas(specify)

D: ACADEMIC QUALIFICATIONS (Authenticated copies of degree and/or diploma certificate(s) must be included with this application)

AWARD / SUBJECT / YEAR / AWARDING BODY / PLACE OF STUDY / Sponsor’s Initials
E: PUBLICATIONS (Continue on additional sheets if required) / Sponsor’s Initials
F: CONTINUING PROFESSIONAL DEVELOPMENT PROGRAMMES /

Sponsor’s Initials

G: MEMBERSHIP OF OTHER BODIES (Professional and/or Scientific)
Name of Organization / Class /

Year Elected

/

Sponsor’s Initials

H: OTHER INFORMATION
/

Sponsor’s Initials

I: PREVIOUS OCCUPATIONS

List in chronological order, with the employer’s name and address, dates and nature of duties. Do not include your current occupation as this is covered in the next section. Please include all periods, whether or not in the geological profession. Continue on additional sheets if necessary.
FROM / TO /

EMPLOYER

(Name and address) /

Applicant’s

Duties / Sponsor’s Initials

J: DETAILS OF PRESENT OCCUPATION and NATURE OF DUTIES

(Brief Description)

/ Sponsor’s Initials

K: LIST OF PROFESSIONAL DOCUMENTS

/
List by number and identifying titles all the Professional Documents submitted in support of this application. Continue on additional sheets if necessary.
Document Number / Title / Sponsor’s Initials
DECLARATION / I declare that I am the principal or sole author of the reports submitted with this application.
SIGNED:

DECLARATION

I declare that I shall abide by the rules of the Institute of Geologists of Ireland.
I shall uphold the highest standards of the Profession as laid out in the Articles of Association and in the Code of Ethics.
Signed:
Name (BLOCK LETTERS)
Date:

IGI Form 4. Revised 25th January 2001, Printed 21/7/10