Fellowship Application Form

Consent for storing submitted data *

Yes, I give permission to store and process my data

See our Privacy Policy listed on our website.

First Name *

Surname *

Date of Birth *

Home Address

Including postcode

Home Phone

Mobile

Home Email *

Job Title

Area of Work

Employer

Work Address

Including dept (if applicable) and postcode

Work Phone

Work Email

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.

Please state which professional registration you hold *

HCPC

RCT

AHCS

Engineering Council

Science Council

Chartered Physicist

International registration (State registration number and registration body)

I am employed in academia with a PhD

Please indicate which best describes you. I am:

Please provide you registration number(s)

If you hold a registration not listed above please state. If you are working in academia with a PhD please state "N/A"

Organisation chart showing with your current position highlighted *

Current CV, maximum 5 pages *

Full list of research and other publications with my name highlighted

A report to justify your application structured according to the three eligibility criteria *

New Applicants Only: Verified copies of your educational certificates which have been signed by one of your Proposers OR provided contact details below of you head of department / line manager who can be contacted to confirm you educational qualifications.

Name of head of department / line manager

Organisation

Telephone

Email Address

Once your membership application is approved we will contact you with instructions on how to pay your membership fee. To help us best assist you please let us know how you would like to pay your membership fee.

The total fee per year stays the same whichever option you pick.

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: