INSTITUT GEOLOGI MALAYSIA

INSTITUTE OF GEOLOGY MALAYSIA

c/o Department of Geology, University of Malaya, 50803 Kuala Lumpur, Malaysia Tel: (603)-79577036 Fax: (603)-79563900

APPLICATION FOR MEMBERSHIP

This is an application for: FELLOW: MEMBER: LICENCIATE: GRADUATE: Fee RM60 Fee RM40 Fee RM40 Fee RM20 Other fees payable: ENTRANCE: TRANSFER Fee RM50 Fee RM50

Please affix a recent passport sized photograph

IGM Membership No. __________________ (for membership transfer only)

1. PERSONAL DETAILS NAME (PROF./ASS. PROF./DR/MR/MS): SEX: FEMALE

________________________________________________________________ MALE

IDENTITY CARD NO: ______________________________ E-MAIL: ______________________________ PHONE [BUSINESS]: ______________________________ [HOME]: ______________________________ MOBILE: _______________________________________ FAX: ___________________________________ BUSINESS ADDRESS: HOME ADDRESS:

Preferred mailing address:

Business

Home

2. EDUCATIONAL BACKGROUND
Name of College/University/Institution Location Degree Year Major Subject(s)

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3. OTHER PROFESSIONAL QUALIFICATION

Date Organization/College/University Title of Course Remarks

4. FIELD OF EXPERTISE/SPECIAL INTEREST

Category Years Involved Reports/Papers

Regional Geology Mineral Exploration / Structural Geology / Sedimentology Mining Geology / Economic Geology Mineralogy / Petrology / Petrography Stratigraphy / Paleontology Petroleum Geology Engineering Geology / Hydrogeology Geophysics Environmental Geology Structural Geology / Sedimentology

Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes Yes

No No No No No No No No No No No No No

5. AFFILIATION WITH OTHER PROFESSIONAL BODIES

Name Of Organization Class Of Membership Year Joined Position Held

6. EMPLOYMENT HISTORY
Employer From To Position Held Company Activities

Instructions:
Please attach: i) Payment with your application. All cheques (crossed), bank drafts, Money Orders or Postal Orders are to be made in favour of Institut Geologi Malaysia and must include sufficient clearing charges. ii) Certified copy/copies of Academic and Professional Qualifications. iii) Relevant document(s) to substantiate your field of expertise. iv) Short resume of yourself in not more than 150 words for inclusion in theDIRECTORY OF GEOLOGISTS.
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7. SPONSORS CERTIFICATION FOR ADMISSION We, the following, attest that to the best of our knowledge the details contained in this application form by __________________________________________ are true and honest. We further attest that we have known the said applicant in proximity for a number of years as per stated and consider him/her to be a fit person to be admitted as a member of the Institute Geology Malaysia.

I.

Name: ______________________________________ Identity Card No : _____________________________ Email: ______________________________________

Membership No: ___________________ Tel No: __________________________ Known applicant for: ___________ (yrs)

_____________________________________________

Date: __________________________

SIGNATURE OF FIRST SPONSOR

II. Name: ______________________________________

Identity Card No : _____________________________ Email: ______________________________________

Membership No: ___________________ Tel No: __________________________ Known applicant for: ___________ (yrs)

____________________________________________

Date: __________________________

SIGNATURE OF SECOND SPONSOR 8. DECLARATION Have you ever been: convicted of a crime? a defendant in a civil action arising out of the practice of geology? indicted for / convicted of felony or misdemeanor other than a traffic violation? subjected to an investigation, injunction or penalties concerning any alleged consumer, investor or securities fraud? Yes Yes Yes Yes No No No No

If you answered yes to any of the above questions, please provide an explanation of the charges and the final judgment and why these charges and judgments are not pertinent to your professional standing and should not be considered in this application. Attached additional sheets if necessary.

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In affixing my signature to this application, I declare that all statements made herein are true and accurate. I further agree to fully cooperate with IGM in the processing of my application and to furnish any additional information as so requested. I hereby grant IGM permission to contact the listed employers, sponsors and any others to verify information contained herein as well as to obtain any information that may be pertinent to this application.

Name: ___________________________________

Date: _____________________

______________________________ SIGNATURE OF APPLICANT

Space below this line for Council use only.

Date received: ___________________

Date approved: __________________

Amount paid RM: ________________

Membership No.: _________________

Secretary/Membership Committee:

President:

____________________________ (Signature)

____________________________ (Signature)

Recognition: Fellows, Members and Licentiates are designated by the abbreviation F.I.G.M., M.I.G.M. and L.I.G.M. respectively. Graduate Members are not assigned any abbreviation. The abbreviation denotes the bearer as a geologist who observes and is bound by the Code of Ethics as laid down by IGM. The Council has the right to expel or suspend any member who is guilty or contravenes the IGM Code of Ethics or any laws introduced to govern the conduct of a geologist following procedures specified in the IGM Constitution.

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ABOUT INSTITUTE OF GEOLOGY MALAYSIA (IGM)

Institute of Geology Malaysia, also known as IGM, was officially registered with the Malaysian Registrar of Societies in 1989. Its establishment was in response to the need of a single body to regulate the profession of geology in Malaysia. The Seal of IGM portrays a hammer flanked by silhouette maps of Peninsular Malaysia and East Malaysia. The Seal depicts the basic tool of the geologists and thus symbolizes the roles of geologists in Malaysia. The objectives of IGM are as follows: To provide a central organization for geologists in the form of a learned and scientific institute for geology and to provide for the definition of, and qualification for, the various branches of the profession of the geological sciences. To promote friendly interaction amongst geologists and to hold meetings for readings and discussion of matters relating to geology and their various arts and sciences connected therewith. To regulate and uphold the dignity, standing and reputation of the profession of geology. To promote and advance the knowledge, study and practice of geology and the various arts and sciences connected therewith. To assist, advise and cooperate with government departments and other private or public bodies in an honourary capacity on questions relating to the science of geology and policy in respect of land and earth resource utilisation and all other matters connected therewith.

1. There are four classes of membership in IGM, namely Fellow, Member, Licenciate and Graduate Member. Fellows, Members and Licenciates are Corporate Members of the Institute. 2. All applications for membership must be proposed by two Corporate Members, one of whom must certify his/her personnel knowledge of the applicant. 3. A candidate for election to the class of Graduate Member must have a Bachelor's Degree with Honours in Geology recognized by the Government of Malaysia or equivalent qualification*.

4. A candidate for election to the class of Licenciate must not be less than twenty-one years of age and must posses the following qualifications: a) at least a Diploma in Geology or equivalent qualification b) experience in a branch of geology of at least five years duration c) passed the membership examinations, if any, athough the Council may exempt a candidate from whole or part of these examinations if he or she has passed other recognized external examinations approved by the Council, and d) be a fit and proper person to become a Licenciate 5. A candidate for election into the class of Member must not be less than twenty-one years of age and must posses the following qualifications: a) a Bachelor's degree with Honours in Geology from a University or Institution of Higher Learning recognized by the Government of Malaysia or equivalent qualification, b) professional experience in a branch of geology of at least three years duration which should include at least one year responsible work in geology, and c) be practising the profession at the time of application and be a fit and proper person to become a Member 6. A candidate for transfer or election into a class of Fellow shall posses the following qualifications: a) be a Member or have satisfied the conditions for admission to the class of Member b) at least fifteen years of professional experience in the geology profession of which at least five years should have been spent in responsible charge of important geological operations or should have been spent as a consultant or advisor in the branches of geology provided that the training and technical experience of the candidate engaged as a consultant or advisor justified such professional status, c) be practising at the time of application and satisfy the Council that he or she is a fit and proper person to become a Fellow 7. All applications must be made on a form prescribed by IGM.

* Equivalent Qualification: i) ii) iii) A minimum of 3 years course duration in an Institute of Higher Learning which offers a degree recognised by the Malaysian Government Public Service Department (JPA). The course must be examination based and must have at lease 50% credit hours in the basic principles of geology or any geoscience branches. A qualification accepted by the Board of Geologists for the purpose of registration as a Professional Geologist under the Geologists Act upon being gazetted.

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