Surname

First Name

Local Authority/Company

Position Description

Home Postal Address

Postcode

Work Postal Address

Postcode

Home Phone

Work Phone

Work Mobile

Home Email

Work Email

Plumber's Lic. No. (if applicable)

Drainer's Lic. No (if applicable)

I hereby apply for admission to the Institute of Plumbing Inpectors, Qld Inc. as

(Please choose appropriate membership)

Individual Ordinary Member (Must be a qualified Plumber/Drainer)
Individual Association Member (Must work in a plumbing related industry)
Retired Member (Fee is $10 per year) - Please contact the IPIQ office to discuss payment

In the event of my election to Membership in any Grade, I agree to be governed by the Model Rules and the By-Laws of the Institute and that I will advance the objects, interest and dignity of the Institute as far as shall be in my power.

I declare that all the statements in this application are correct and undertake, if called upon, to submit written proof of same and to supply any other relevant information that may be requested.

Your membership is required to be Proposed and Seconded. We will contact your Proposer and Seconder on your behalf. If you do not have a Proposer or Seconder we will find one for you. The Proposer and Seconder must both be current financial members of the IPIQ

Please enter the name and email address of your Proposer

Please enter the name and email address of your Seconder