Full Membership Application Form

See our Privacy Policy listed on our website.

Consent for storing submitted data *

Yes, I give permission to store and process my data

First Name *

Surname *

Date of Birth *

Home Address *

Home Postcode *

Home Phone

Mobile

Home Email *

Current IPEM Membership Grade

If Applicable

IPEM Membership Reference Number

If you choose to pay for your IPEM Membership by Direct Debit (Annually or Monthly), you must sign and return a Direct Debit Mandate form to us along with your application.

Details on ways to pay for your membership can be found on the IPEM website here.

The Direct Debit mandate form can be downloaded here and uploaded below. Please note that a wet signature is required on these forms.

Promotional Code

If you are an existing IPEM member applying to upgrade your membership and have been issued a promotional code, please enter it here

Job Title *

Area of Work

Employer *

Work Address

Including department (if applicable)

Work Postcode

Work Phone

Work Email

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:

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

Other

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"

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)