Associate Membership Application Form

Contact Information

Consent for storing submitted data *

Yes, I give permission to store and process my data

Please see our Privacy Policy on the website.

First Name *

Surname *

Date of Birth *

Home Address *

Home Postcode *

Home Phone

Mobile

Home Email *

Professional information

Please only provide academic information if you are CURRENTLY studying. If you have already graduated you should provide your current EMPLOYMENT information.

Course level (if applicable) - BSc, BEng, MSc, etc

Expected Graduation Date (if applicable)

Job or Course Title *

Employer or University *

Work or Term Time Address including department (if applicable) *

Work Postcode

Work Phone

Work Email

Which registration(s) are you working towards? (e.g. HCPC, RCT, CEng, CSci)

If applicable

Contact preferences

Phone number *

We need at least one phone number for you (mobile, home or work) as we might have to contact you about your application.

Membership Eligibility

Tell us about the area you are studying or working in

Confirmation of eligibility

Verifier Name *

As part of the application process your verifier will be contacted to confirm your eligibility for Associate Membership. Your verifier should be your line manager, course tutor or supervisor.

Verifier Email *

Verifier job title *

Verifier relationship to you *

(Line manager, supervisor, etc)

Paying your membership fee

If you choose to pay for your IPEM Membership by Direct Debit (Annually or Monthly), you must complete the online Direct Debit Mandate form. Details on ways to pay for your membership can be found on the IPEM website here.

IOP Registration Number (if applicable)

If you are also a member of the Institute of Physics (IOP) you are entitled to 25% discount on your membership fee. Please state your IOP membership category and number

Terms and conditions of payment of annual fees by monthly Direct Debit
1. Monthly Direct Debit installments will be the annual fee divided by 12 and rounded down to the nearest penny.
2. IPEM will collect the monthly Direct Debit instalments on the dates shown on the Direct Debit advance notification, from the IPEM member/RCT registrant’s bank account. For annual renewals these are normally on the 8th of each month. For other payments these are normally on the 8th or the 22nd of the month.
3. If IPEM is unable to collect any Direct Debit instalment from any IPEM member/RCT registrant’s bank account (Bounced DD collection) when it is due, then IPEM will re-present the Direct Debit Instalment collection on the next collection and inform the IPEM member/RCT registrant of this. IPEM collect on the 8th and the 22nd of each calendar month.
4. If IPEM is still unable to collect the DD instalment from the IPEM member/RCT registrant’s bank account after the second attempt, then IPEM will inform the IPEM member/RCT registrant and ask the member/registrant to pay all the instalments due for the remainder of the year.
5. If an IPEM member then fails to pay all the instalments due within 30 days the IPEM Membership will be suspended. (Note this deadline will be extended to the 28th/29th February for IPEM membership if necessary to coincide with the IPEM grace rules, if applicable)
6. If an RCT registrant then fails to pay all the instalments due within 30 days the RCT registration status will be marked as lapsed.
7. If the IPEM membership is suspended, all additional products that depend on Membership of IPEM (Science Council & Engineering Council registration and Journal subscriptions) will be cancelled without refund.

Terms and conditions of payment of annual fees by Annual Direct Debit
1. IPEM will collect the Annual Direct Debit payment on the date shown on the Direct Debit advance notification from the IPEM member/RCT registrant’s bank account. For annual renewals these are normally on the 8th January. For other payments these are normally the 8th or the 22nd of the month.
2. If IPEM is unable to collect any Direct Debit payment from any IPEM member/RCT registrant’s bank account (Bounced DD collection) when it is due, then IPEM will re-present the Direct Debit collection on the next available collection date and inform the IPEM member/RCT registrant of this. The next collection is normally the 22nd January. For other payments these are normally on the 8th or 22nd of the month.
3. If IPEM is still unable to collect the DD payment from the IPEM member/RCT registrant’s bank account after the second attempt, then IPEM will inform the IPEM member/RCT registrant and ask the member/registrant to pay the fee by another method.
4. If an IPEM member then fails to pay within 30 days the IPEM membership will be suspended. (Note this deadline will be extended to the 28th/29th February for IPEM membership if necessary to coincide with the IPEM grace rules, if applicable)
5. If an RCT registrant then fails to pay within 30 days then RCT registration status will be marked as lapsed.