Today's Date
Membership ID No.
Type of Membership (Tick appropriately)
Student
Graduate
Pln. Technician
Corporate
Honorary Fellow
Fellow
Current Membership Status
None
Student
Graduate
Pln. Technician
Corporate
Honorary Fellow
Fellow
A. PERSONAL INFORMATION
Surname
First Name
Other Name
Date Of Birth
Place Of Birth
Nationality
Passport Size Photograph
Gender
Male
Female
Marital Status
Married
Single
B. CONTACT DETAILS
Current Place of Residence
Street Name
Property Number
Town/City
District
Country
Digital Address
Email
Phone
C. CURRENT EMPLOYMENT
Employer/ Company / Organization
Workplace Phone No.
Company Email Address
Company / Organization Address
D. EDUCATION DETAILS
School/ Institution
Year of Graduation
Course / Program
Certificate Obtained
School/ Institution
Year of Graduation
Course / Program
Certificate Obtained
E. PROFESSIONAL TRAINING DETAILS
Course / Program
Training Institution
Start Date
End Date
Course / Program
Training Institution
Start Date
End Date
F. EMPLOYMENT HISTORY
Name of Employer
Position Held
From
To
Name of Employer
Position Held
From
To
G. OTHER PROFESSIONAL AFFILIATIONS
Are you member of any other Professional Association?
Yes
No
Name of Professional Association (s)
Class of Membership
Year joined
I. PROFESSIONAL SPECIALTY
Indicate your field of specialization
Brief description of area of specialization
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UNDERTAKEN
I, desirous of being admitted into the GHANA INSTITUTE OF PLANNERS and having read the Constitution and By-Laws of the said Institute and finding that in conformity with these, I am eligible as a Fellow /Corporate /Associate /Student Member I do hereby undertake if elected to be bound thereby by the Constitution of the said Institution any By-Laws, Rules, and Regulations.
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