Application_form_of_Student模板.docVIP

Application for Student Membership 注意：请同时附上《》For classes other than student, please contact the Institute CIOB China Chartered Institute of Building, China Telephone: +86-10-6528 1070 Facsimile: +86-10-6528 1075 E-mail Address: memenquiry@ Room 11B, CITIC Building, No 19 Jian Guo Men Wai Street, Beijing, 100004, China Form M1 APPLICANT’S DETAILS PLEASE USE BLOCK LETTERS Surname T a n Forenames P eng Title Sex M/F Date of Birth M 1 9 8 3 0 8 0 2 Home Address No.88-56, North Tuanjie Street, Lishan District , Anshan , Liaoning Province Post Code 1 1 4 0 3 1 Telephone 0 4 1 2 6 3 4 0 2 7 1 Mobile Phone E-mail 1 2 3 4 5 6 7 8 9 xiaotian444@163.com FULL TIME STUDENT Term Time Address N o. 1 7 4 , S h a z h e n g S t r e e t , Shapingba District , Chongqing Post Code Telephone 4 0 0 0 4 5 Mobile Phone E-mail 1 5 8 2 6 0 0 0 0 0 0 xiaotian444@163.com PART TIME STUDENT Business Address including job title and company name Office Telephone Mobile phone Fax E-mail Please inform the Institute of any change of address FREE STUDENT MEMBERSHIP An application for free Student Membership may only be made under the conditions laid out in 1.1 of the Membership Notes please see reverse for details . Please tick box if eligible for free Student Membership √ APPLICANTS DECLARATION I wish to be admitted into membership of the Student class of the Chartered Institute of Building and if admitted, undertake to observe the Charter, the Bye-Laws and the regulations for the time being in force. I declare that the statements on this form and in any accompanying documents are true. Signature Tanyue Date 2008 04 26 The CIOB processes member information in accordance with the Data Protection Act 1988. A copy of the full CIOB Privacy Policy is available on request. Occasionally, where there is judged to be benefit to members, appropriate data may be passed to a third party. If you wish to be incl