Volunteer Applications

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

Email *

Daytime Phone Number *

Your preferred number, can be a mobile

Current place of work *

Hospital, university, company etc. We do not need the address

Membership Number

Please leave blank if you can't find it or you are applying as a lay member

In what area of the profession do you work in, what do you do? *

Please state your specialism / interest and your current role / work.

Please indicate if you have any of the specific areas of experience, skills and attributes as outlined in the role description and eligibility criteria document. *

Please state how your skills, enthusiasm, experience can help IPEM achieve the aims and objectives of this group? Why do you want to get involved? *

Optional - have you done any previous volunteering? (with IPEM or outside of IPEM) *

If applicable please include approximate dates and role and comment on what experience, skills or knowledge you gained.