European Academy of Engineering (EAE) Membership Endorsement Form

First Name (As Shown on Passport)^* Required

Last Name (As Shown on Passport)^* Required

Middle Name (Where Applicable)

Nationality^* Required –select country– Afghanistan Aland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan the Plurinational State of Bolivia Bonaire Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo the Democratic Republic of the Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hungary Iceland India Indonesia the Islamic Republic of Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati the Democratic People's Republic of Korea the Republic of Korea Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao the former Yugoslav Republic of Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico the Republic of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan the United Republic of Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu the Bolivarian Republic of Venezuela Viet Nam The British Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

Passport Number^* Required

Passport Expiry Date^* Required

2nd Nationality(Where Applicable) –select country– Afghanistan Aland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan the Plurinational State of Bolivia Bonaire Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo the Democratic Republic of the Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hungary Iceland India Indonesia the Islamic Republic of Iran Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati the Democratic People's Republic of Korea the Republic of Korea Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macao the former Yugoslav Republic of Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Martinique Mauritania Mauritius Mayotte Mexico the Republic of Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Norway Oman Pakistan Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan Tajikistan the United Republic of Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu the Bolivarian Republic of Venezuela Viet Nam The British Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe

Date of Birth(DD/MM/YYYY)^* Required

Personal Photograph^* Required Select File

Current Title^* Required

Current Affiliation^* Required

Work Phone^* Required

Mobile Phone^* Required

Email^* Required

Mailling Address^* Required

–select class– Fundamental Sciences and Mathematics Science (F.M.S.) Computer Science and Information Technology (C.S.E.) Electronics and Electrical Engineering (E.E.E.) Mechanical Engineering (Materials) (M.M.E.) Chemical Engineering (C.H.E.) Biomedical Engineering (B.M.E.) Civil and Environmental Engineering (C.V.E.) Energy and Resource Engineering (E.R.E.) Aerospace and Transportation Engineering (A.T.E.) Agriculture and Food Engineering (A.F.E.) Industrial and Manufacturing Engineering (I.M.E.) Metallurgy and Materials Engineering (M.A.E.) Process Systems Engineering and Engineering Management (P.S.E.)

Email^* Required

Primary Phone Number^* Required

Work Phone Number^* Required

Please provide detailed written statement to the following questions. Your input will help evaluate the nominee's qualifications for the exclusive EAE membership.

Describe the nominee's significant contributions to the field of engineering. Include specific projects, innovations, publications, patents, or leadership roles. (1000 words maximum)^* Required

Explain how the nominee's work aligns with EAE's mission to advance engineering excellence in Europe. (1000 words maximum)^* Required

Discuss the nominee's potential to contribute to the academy's activities, initiatives, and goals. (250 words maximum)^* Required

Describe any previous collaborations or interactions you've had with the nominee, highlighting their impact on the engineering community. (250 words maximum)

List any honors, awards, or recognitions received by the nominee for their engineering achievements or breakthrough. (20 entries maximum)^* Required

State why you believe the nominee should be considered for EAE membership and how they will enhance the academy's mission. (500 words maximum)^* Required

Referee 1

Name^* Required

Title^* Required

Email^* Required

Phone^* Required

Referee 2

Name^* Required

Title^* Required

Email^* Required

Phone^* Required

Personal Statement (Nominee)^* Required

Instructions

Please provide a personal statement outlining your qualifications, achievements, and reasons for seeking membership in the European Academy of Engineering (EAE). This statement is an opportunity for candidate to share their background, experiences, and the commitments to contributing to the goals and mission of EAE, and how their work can reshape Europe’s future of engineering.

Please attach a file of a personal statement of no more than 2000 words. You may consider addressing the following points.

* Your academic and professional background.
* Significant achievements, contributions, or innovations in your field and how they are going to influence EU future.
* How your expertise aligns with the objectives and focus areas of EAE.
* Your commitment to promoting engineering excellence and advancing the field in EU.
* Any specific contributions or initiatives you plan to undertake as an EAE member.

Please take your time to provide a thoughtful and comprehensive personal statement. Your statement will be an important part of the evaluation process for EAE membership.

Please ensure that the nominee is aware of and agrees to this nomination.