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Subject *

Name *

Format: FirstName LASTNAME

Email (private) *

Phone number (private)

Date of birth *

Gender *

Female

Male

Other

Nationality *

Number, Street (home) *

Postal code (home) *

Format: L-1330

Locality (home) *

Country (home) *

Please choose an option *

I have a degree (or am in the process of obtaining a degree) in the field of engineering, applied sciences or exact sciences

I wish to support the mission and activities of Ingénieurs et Scientifiques du Luxembourg

Please indicate your level of education *

B.Sc. / B.Eng.

M.Sc. / M.Eng.

PhD

If you are still a student, become a member of ANEIL (and you will automatically be a member of our association)

University *

Degree *

Specialisation *

Graduation (year) *

Copy of my diploma

Please upload one or more files (max. 5)

Would you like to provide a second degree? *

Yes

No

University (degree 2) *

Degree (degree 2) *

Specialisation (degree 2) *

Graduation (year) (degree 2) *

Copy of my diploma (degree 2)

Please upload one or more files (max. 5)

Please justify your application. What is your connection to our association? *

Are you currently under an active employment contract? *

Yes

No

Employer *

Position

Number, Street (employer)

Postal code (employer)

Format: L-1330

Locality (employer)

Country (employer) *

Professional email

Professional phone

I give my consent *

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