THE INTERNATIONAL INSTITUTE
OF
RAIL ELECTRIFICATION ENGINEERS

Membership Application Form
Send correspondence to: q Home Address q Company Address
PLEASE PRINT - If last name is not family name, circle first letter of family name.
First Name_________________________Middle Name_____________________
Last Name_________________________Date of Birth_______q Male q Female
Full Home Address__________________________________________________
_________________________________________________________________
_________________________________________________________________
Home Telephone______________________Fax___________________________
E-mail Address___________________________________
Present occupation__________________________________________________
Number of years in professional practice__________________________________
Company Name____________________________________________________
Address__________________________________________________________
________________________________________________________________
________________________________________________________________
Business Telephone______________________Fax_________________________
E-mail__________________________________________
Educational Information:
University/College - Name and Address___________________________________
_________________________________________________________________
_________________________________________________________________
Academic Qualifications and Date Received________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
For more information (optional)



United Kingdom Data Protection Act: All members will have their names and addresses included in
the Institute's computer database. This database will be used for Institute Records and Journals
ONLY and will NOT be divulged to outside sources.

I hereby make application for IIREE membership and, if elected, will be governed by IIREE's
Constitution, By-laws, Statements of Policies, Code of Ethics and Procedures.

Full Signature of Applicant______________________________________Date___________________

Send to: The Secretary, IIREE, 6 Rectory Close, Wootton, Isle of Wight PO33 4QB England UK

M41 Issue 2 1996
1