Barratt House, Kingsthorpe Road, Northampton, NN2 6EZ

TEL: +44 (0) 1604 438222

E-mail: admin@icorr.org Web site: www.icorr.org

TRANSFER TO PROFESSIONAL MEMBERSHIP 2017/2018

(Please TYPE or PRINT in black ink as this form will be photocopied. * Delete as appropriate)

Please ensure that you are an Ordinary Member of ICorr

before applying for upgrade to Professional Member
CATEGORY OF MEMBERSHIP REQUESTED (see Guidance Note A) MICorr
Present Grade * Ordinary Student Technician
Membership Number Date of Joining
Mr/Mrs/Miss/Ms/Dr/Prof SURNAME
FORENAMES (in full):
DESIGNATORY LETTERS BSc, CEng, MIMF, etc Date Of Birth
PRIVATE ADDRESS
including postcode

EMPLOYER Date Of Joining

APPOINTMENT HELD
BUSINESS ADDRESS
Including postcode

Home Business
TELEPHONE
Mobile Fax
Email (for correspondence)
Which Address Do You Want To Use For Correspondence And The Journal Home/Business
WHICH BRANCH AND DIVISION(S) DO YOU WISH TO JOIN? (please indicate)
Branch: Aberdeen London North East North West Yorkshire Midlands
Division(s) Corrosion Engineering Corrosion Science
DECLARATION (to be signed by all applicants)

Registered office as above. A company limited by guarantee and registered in England No 1240103. Registered Charity No 275206
 PROFESSIONAL MEMBERSHIP APPLICATION/ TRANSFER Page 2 of 5

I hereby confirm that, if elected as a Professional Member I will observe the Institute's Articles of Association and Byelaws
and any regulations made thereunder, and will conduct myself honourably in the practice of my profession. I certify that
the information on this application form and any attachment(s) is correct to the best of my knowledge and belief, and that
I will abide by the decision of Council of the Institute in pursuance of this application.

Signed: .................................................................................................... Date:

................................................................................

REFEREES (see note B) To be completed by the referees personally after verifying and, where appropriate, attesting
the content of the application and attachments.
I confirm that I have read the Regulations appropriate to the grade of Professional Member for which this application is
being made, and I recommend that the applicant, to the best of my knowledge and belief, is a fit person to be admitted
to professional membership of the Institute. I agree, on request by the Institute, to provide a confidential written
reference.
Referee 1
Name: Grade:
Address

Tel No Email

Signature Date

Referee 2
Name: Grade:
Address

Tel No Email

Signature Date

EDUCATION (see note C)

Institution attended Dates Subjects studied Qualifications Year awarded
obtained
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PROFESSIONAL QUALIFICATIONS (see note D)

Please give name of awarding body, date of election and grade of membership.

KNOWLEDGE OF CORROSION FUNDAMENTALS AND CORROSION CONTROL METHODS (see note E)

Please give details of courses/training where this knowledge was attained.
It is imperative that this information is given as fully as possible for the application to be considered.

PUBLICATIONS AND REPORTS (see notes F and G)

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Please continue on a separate sheet if necessary.

TRAINING AND EXPERIENCE (see notes H, J and K)
Please attach your CV and an Attested Training and Experience Report
NOTE: Under Regulation 21, applicants may be requested to attend an interview at which they will be invited to expand
on their training and experience. This is not normally requested until the Committee has considered the application and
references and further information is required.

ENCLOSURES (see note L)

Please list the documents (attested copies) enclosed. Please do not send originals of certificates.

FEES (see membership subscription rates schedule and note M)

Registration fee: __15.00_______

Difference between Ordinary membership and Upgrade membership
__32.00_______

_______________

Total payment to ICorr _______________

PAYMENT ADVICE

EITHER I enclose cheque/money order payable to Institute of Corrosion for GB ___________

OR Please debit my Debit / Credit card:

Name on Card

Card Number Expiry Date

 PROFESSIONAL MEMBERSHIP APPLICATION/ TRANSFER Page 5 of 5

Security 3 digit Number

Signed: ....................................................................................................... Date: .........................................................