Volunteer Application Form

Consent for storing submitted data *

Yes, I give permission to store and process my data

Application for? (title of role) *

Full Name *

Membership No

Grade of Membership *

Daytime 'phone number *

Mobile 'phone Number *

Email *

Current place(s) of work

Your specialism *

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, experience and achievements to date would make you a suitable candidate for this role and why you wish to undertake it. *

Summary of any volunteer roles undertaken within and outside IPEM *

include approximate dates, title of role and comment on experience, skills or knowledge gained.

Name and email address of your supporting members of the Institute (for Board and Pre-Board positions only)