Enter which of these grades you wish to apply for: MIED/AIED/CDAIED
If applying for ECuk registration, please indicate at which level: CEng/IEng/EngTech
NAME IN FULL
DEGREES, DESIGNATORY LETTERS etc
INITIALS, SURNAME & FULL POSTAL ADDRESS (as it should appear on an envelope addressed to the applicant)
EMAIL / TELEPHONE
DATE OF BIRTH / NATIONALITY / FOLIO
ENGINEERING FIELD
PRESENT POSITION
EMPLOYER’S NAME AND ADDRESS / S/INDEX
EMAIL / DAYTIME PHONE
1st Referee’s Name – all applications
Address / Email
2nd Referee’s Name – all applications
Address / Email
3rd Referee’s Name – applications for MIED/CEng/IEng
Address / Email
4th Referee’s Name – necessary only if you have known any of the above less than two years
Address / Email
Have you previously made an application for membership to this Institution? YES/NO
If Yes, please give grade applied for and if possible date / PROPOSER’S INITIALS
FURTHER & HIGHER EDUCATION
Dates Studied / Where / Subject / Qualification Awarded
MEMBERSHIP OF OTHER PROFESSIONAL BODIES
RELEVANT PROFESSIONAL TRAINING/CPD EVIDENCE
Form of training or work undertaken, company or establishment, departments, covered, etc
From / To
Mth / Yr / Mth / Yr
PROFESSIONAL EXPERIENCE IN ENGINEERING DRAUGHTING AND DESIGN
State in reverse chronological order- most recent first, of when and where, in what capacity and branch of engineering you gained your professional experience.
An expanded and more detailed description of your role should be covered in the professional review report
From / To / Position / Brief Description of Role
Mth / Yr / Mth / Yr
/ PROPOSER’S INITIALS
OTHER RELEVANT EXPERIENCE OR INFORMATION
Including patents, registered designs, papers published or awards not already covered elsewhere in this form.
PROPOSER’S DECLARATION:- Having known the applicant for …… years, I wish to propose the applicant for Membership of the Institution and certify that to the best of my knowledge the information initialled by me on this application form is true and correct.
Signed Dated
APPLICANT’S DECLARATION
  • I certify that the statements I have made in connection with this application are true and correct.
  • I enclose the Application Fee of £ 135 by cheque/postal order/money order/cash, made payable to the “Institution of Engineering Designers”.
I would like to pay by Debit/Credit Card (Visa, Mastercard, Switch or Solo accepted).
/
Card No / Expiry Date / Issue No
3-digit Security Code
SIGNED DATE
This form should be returned when completed to:- The Secretary, INSTITUTION OF ENGINEERING DESIGNERS, Courtleigh, Westbury Leigh, Westbury, Wiltshire, BA13 3TA, England.