MRSE Certificate of Competence

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Personal Information

First Name *

Surname *

Professional Information

ABMRS status *

MRSC™ MRSE

Exam Location UK

Exam Location Other

ABMRS MRSE expiry date:

Contact Information

Job Title

Employer

(IPEM members: we will take this information from your existing membership record. Please ensure that this is up to date by logging in via MyIPEM.)

Work Address

Including dept (if applicable) and postcode

Work Email

Home Address

Including postcode

Home Email

Supporting Evidence

Please upload all supporting documents *

This should include the experience cross reference table and all relevant certificates. You may upload multiple documents

ALL applicants must complete the section below (please tick the appropriate boxes):

I understand that upon processing of my application form IPEM will invoice me the application fee of £75.00, to be paid by Debit/Credit card online via MyIPEM or over the phone

Declaration

I wish to apply for the IPEM MRSE Certificate of Competence and declare that the information I have given in this application is to the best of my knowledge accurate and true. When acting in the role of an MR Safety Expert I will comply with any professional standards and registration requirements relevant to the context in which the advice is provided.