Step 1 - Profile Details

    Application for Chartered Professional Program and/or RPEQ Assessment

    Do you have a web user account? * Yes No


    Please select one of the following options:




    What do you want to apply for?




    Discipline*

    * designates required fields

    Personal Info

    Prefix *
    First Name *
    Last Name *
    Suffix
    Post Nominal
    Preferred First Name *
    Gender *
    Birthday * dd/mm/yyyy

    Email Addresses

    Primary Email *
    Secondary Email
    Membership Number

    Organisation Details

    Organisation
    Position/Title

    Contact Details

    Business Address

    Country*
    Street / PO Box Address*
     
     
    City / Suburb*
    State*
    Post / Zip Code*

    Home Address

    Country*
    Street / PO Box Address*
     
     
    City / Suburb*
    State*
    Post / Zip Code*

    Preferred Addresses

    Mailing Address *
    Billing Address *

    Contact Numbers *

    Country Code + Area Code + Phone Number
    Business Phone    
    Home Phone    
    Mobile    

    Web Registration Info

    Web Registration Info
     

    The information entered here will become your AusIMM web user account.

    Please enter a web user ID and password for your online account. (Spaces cannot be used in either)

    User ID *

    Password *

    Retype Password *