AMEU: Women in Electricity
Title
Ms
Mr
Dr
Prof
Name:
Surname:
Phone Number
Cell Number:
Email Address:
Organisation/Company Name (Please include province and city):
Postal Address
Qualifications:
Current Job Description:
Years of Experience:
Age category
18-25
25 -35
35-50
50+
Are you registered with any professional bodies?
Yes
No
If yes (which one? Which category?)
What are your specialities?
Would you like to be allocated a mentor?
Yes
No
If Yes, please tick the nature of membership required
Technical Mentorship for ECSA registration
Leadership Mentorship
Do you want to be a mentor?
Yes
No
If yes, which area/s?
Contact Information