SECTION D: MEMBERSHIP OF OTHER PROFESSIONAL BODIES/PROFESSIONAL QUALIFICATIONS
Name of Institute/Professional Body/Grade/date achieved
SECTION E: SUMMARY OF CAREER PROGRESSION/WORKING EXPERIENCE
provide information dating back the past five years
EMPLOYER/ORGANIZATION + JOB TITLE + DATE
SECTION F : DECLARATION
I agree that irrespective of the professional membership grade for which I have applied, I will accept the
grade of professional membership considered appropriate and awarded me by the Membership Committee
of the Institute. Should I be inducted and a Membership Certificate be issued to me, I understand that it
remains the property of ICIMN and that I must return it to the Institute upon cessation of membership. I agree
to adhere to the Code of Conduct and Membership Regulations of ICIMN. I hereby, submit my application
for membership and declare that all the information given on this form is accurate and true.
