Illuminating Engineering Society of Australia and New Zealand Limited
ABN 99 100 686 039	
Secretariat: PO Box 576 Crows Nest NSW 1585 AUSTRALIA
Telephone +61 2 9431 8663 Facsimile +61 2 94318677
Email: Secretariat@iesanz.org    www.iesanz.org

REGISTERED LIGHTING PRACTITIONER APPLICATION FORM
(Note: Applicants must complete three copies of this Application Form. All sections must be fully completed by typing or legible handwriting; reference to any previous application is insufficient. Please refer to the attached Guide for advice on how to complete this Application Form.
Please use the tab key between entry fields.  Do not use the enter key
PART 1: APPLICANT’S DETAILS
A.	PERSONAL
Name of Applicant:		      
Residential Address:		(#/Street:)      		(Suburb:)      
	(State:)     	(Postcode:)      	(Country:)     
Contact Details:	(Phone:)     	(Mobile:)      
(E-mail:)       
(Current membership grade:)     
B.	EMPLOYMENT
Company or Organisation:		     	
Current position (title or designation):     
Business address:		(#/Street:)      		(Suburb:)      
	(State:)     	(Postcode:)      	(Country:)     
Contact Details:	(Phone:)     	(Mobile:)      
(E-mail:)      

PART 2: REFEREES
Please provide the names, qualifications, addresses and telephone numbers of three persons who have personal knowledge of your work and who are willing to act as referee and to furnish a confidential report on this application. At least two of the referees should preferably be Fellows or Members of the Society. Persons of standing in other professional Institutions are also acceptable. Please note that the RLP Committee of the Society reserves the right to make enquiries of other members of the lighting profession regarding your application and it is implied that in making this application, you give permission for such enquiries to be made.

Name of Referee:	     		Qualifications:      
Address:		#/Street     			Suburb:     
			State:     		Postcode:     		Country:     
Contact		Phone:     	Fax:     	Mobile:     
Details:		Email:     

Name of Referee:	     		Qualifications:       
Address:		#/Street     			Suburb:     
			State:     		Postcode:     		Country:     
Contact		Phone:     	Fax:     	Mobile:     
Details:		Email:     

Name of Referee:	     		Qualifications:      
Address:		#/Street     			Suburb:     
			State:     		Postcode:     		Country:     
Contact		Phone:     	Fax:     	Mobile:     
Details:		Email:

PART 3: LIGHTING PRACTICE - General
Give broad details of a selection of Lighting projects completed over the last 5 years in which you had a major involvement in the lighting design.

Year	Project	Your Involvement	Referee's
Referee's	
     	     	     		
     	     	     		
     	     	     		
     	     	     		
     	     	     		
     	     	     		
     	     	     		
     	     	     		
     	     	     		
     	     	     		
     	     	     		
     	     	     		
     	     	     		
     	     	     		
     	     	     		
     	     	     		
     	     	     		
     	     	     		

PART 4: LIGHTING PRACTICE - Detailed
Provide a folio submission of two (2) fully described lighting projects undertaken in the last 5 years complete with drawings, calculations, photographs and similar evidence of the high quality of the lighting design involved.
Indicate names of projects here, and add details on separate sheets.
Names of Projects:

1.	     

2.	     
PART 5: LIGHTING DESIGN AWARDS
Provide details of any LiDA (or MLA) Certificates awarded to you in the last 5 years. Note that this is not a requirement of obtaining RLP recognition.

     

PART 6: CONTINUING PROFESSIONAL DEVELOPMENT
To retain the grade of Registered Lighting Practitioner there is a requirement that you undertake regular Continuing Professional Development. Details of the current CPD requirements are shown in the attached CPD Guide.
DECLARATION BY APPLICANT
I declare that the foregoing particulars are correct to the best of my knowledge and belief.
If this application is accepted, I agree to abide by the Society's Constitution and published Code of Ethics and to undertake regular Continuing Professional Development as defined and published from time to time by the Society.
Signed:	Date:   /  /    
The three (3) completed copies of this application form, together with three (3) copies of all supporting documentation should be returned to your Chapter Secretary (refer to the Society’s website www.iesanz.org for the contact details for your Chapter).
CODE OF ETHICS
To preserve the confidence of the community in the integrity and judgement of the Society, the Board requires members in all grades to conform in their personal, business and professional life with the letter and the spirit of the Code of Ethics:
•	Maintain high standards of objectivity and integrity in their professional work.
•	Exercise scientific caution and regard for the limits of present knowledge in their professional reporting avoiding exaggeration, sensationalism and superficiality.
•	Seek to direct their work and disseminate knowledge toward improving the well being of individuals and promoting the aims of the Society.
•	Strive to keep up to date in their knowledge and application of this knowledge in the areas of lighting in which they practise.
•	In any situation where a conflict may arise ensure that they have defined the nature and direction of their loyalties and informed all parties of them.
•	Refer people to competent colleagues for services, which fall outside their own competence.
•	Refrain from adverse public comment or criticism of the views, services or conduct of a professional colleague, unless the person's activity endangers the rights or well being of others.
•	Accept the obligation to disseminate their special knowledge of lighting by means of publication and the technical meetings of the Society, and in doing so to acknowledge any others who have contributed to the information presented.
•	Not lay false claim to professional qualifications, affiliations, characteristics or capabilities for themselves or for their organisations.
•	Not allow their names to be used in connection with their services in such a way as to misrepresent the nature and efficiency of these services.