Full Membership Application Form

Contact Information

Consent for storing submitted data *

Yes, I give permission to store and process my data

See our Privacy Policy listed on our website.

Title *

Other title

First Name *

Surname *

Date of Birth *

Home Address *

Home Postcode *

Home Phone

Mobile

Home Email *

Professional information

Job Title *

Area of Work *

Employer *

Work Address *

Including department (if applicable)

Work Postcode

Work Phone

Work Email *

Contact preferences

Please send correspondence to *

Phone number *

We need at least one phone for you as we might have to contact you about your application

Membership Eligibility

Please state which professional registration you hold *

HCPC

RCT

AHCS

Engineering Council

Science Council

Chartered Physicist

I am employed in academia with a PhD

Other (e.g. International registration)

Please provide you registration number(s)

If other registration - Please give details such as e.g. your international state registration number and registration body.

Confirmation of eligibility

Verifier Name *

As part of the application process your verifier will be contacted to confirm your eligibility for Full 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)

Interests

Academic

Diagnostic Radiology

Industry

Informatics and Computing

Biomedical Engineering

Magnetic Resonance

Nuclear Medicine

Physiological Measurement

Radiation Protection

Radiotherapy

Rehabilitation and Biomechanics

Ultrasound and Non-Ionising Radiation

Trainee

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:

Have you completed the IPEM Clinical Technologist Training Scheme within the last six months and also currently have RCT registration?

If you have you are eligible for a 50% discount for your first year of membership

Invoice or Direct Debit? *

Instruction to your bank or building society to pay by Direct Debit

Please pay the Institute of Physics and Engineering in Medicine Direct Debits from the account detailed in this Instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that this Instruction may remain with the Institute of Physics and Engineering in Medicine and, if so, details will be passed electronically to my bank/building society.

Service User Number: 830217
Institute of Physics and Engineering in Medicine
Fairmount House
230 Tadcaster Road
York
YO23 1PB
Tel: 01904 610821

The Direct Debit Guarantee

This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits
If there are any changes to the amount, date or frequency of your Direct Debit the Institute of Physics and Engineering in Medicine will notify you 7 working days in advance of your account being debited or as otherwise agreed. If you request the Institute of Physics and Engineering in Medicine to collect a payment, confirmation of the amount and date will be given to you at the time of the request.
If an error is made in the payment of your Direct Debit, by the Institute of Physics and Engineering in Medicine or your bank or building society you are entitled to a full and immediate refund of the amount paid from your bank or building society
If you receive a refund you are not entitled to, you must pay it back when the Institute of Physics and Engineering in Medicine asks you to.
You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

Direct Debits payments must be from a UK bank account

Name(s) of Account holder(s) authorised to set up this Direct Debit *

Name of your bank or building society *

Please note the Direct Debit reference name on your bank statement will be IPEM.

Bank or building society account number *

Sort code *

I would like to pay the following by Direct Debit (tick ALL that apply). Please note all fees to the Science & Engineering Council and for Journal Subscriptions must be paid annually. *

IPEM membership fee ANNUAL

IPEM membership fee MONTHLY

RCT membership fee ANNUAL

RCT membership fee MONTHLY

Science Council registration fee ANNUAL

Engineering Council registration fee MONTHLY

Journal Subcriptions (PMB,PM,MEP) ANNUAL (subcription is included for Full Members and Fellows)

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.

Confirmation

I have read, understood and accept the terms and conditions of paying my fees by Direct Debit and would like to proceed.

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