7/29/2019 IET Student Application Form(1).pdf

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Please specify the address that you would like all correspondence sent to: Home Term Time

Student

Application FormI you require assistance or advice please telephone +44 (0)1438 765678 or visit www.theiet.org/contactmembership. Your annual subscription must accompany this

orm. Your subscription year will run annually rom the date that you joined the Institution o Engineering and Technology. Please send the completed application orm to:

Membership Application Team, The IET, Michael Faraday House, Six Hills Way, Stevenage, Herts SG1 2AY UK.

Date o BirthSurname/Family Name

Your Details

Personal Details

I understand and consent to the inormation provided on this orm being processed by the IET or its sole use and that o its associated organisations, including my Local Network, or the purpose o

promoting, delivering and improving my experience o the IET and its product and services or such other purposes as are described in the IET Privacy Statement. I either now or in the uture I am based

outside the European Economic Area (the EEA), my inormation may be transerred outside the EEA (or example to my Local Network or IET Global Ofce) to enable me to beneft rom the IET

opportunities overseas or, where required, to enable the IET to meet any legal or other legitimate obligations in that country. The benefts o IET membership are enjoyed by our members globally.

However i you do not wish to receive notifcation o IET products and services which may be o interest and beneft to you (by post or electronic means) please tick this box.

Data Protection

Please specify your gender: Male Female

PLEASE USE BLACK INK AND WRITE CLEARLY IN THE BOXES IN BLOCK CAPITALS . ANY MISTAKES OR MISSING INFORMATION MAY DELAY YOUR APPLICATION.

d d m m y y y y

Home Address

Postcode CountryCounty/State

Telephone Mobile

Home Email Address

Term Time Address

Postcode CountryCounty/State

Term Time Email Address

Education

Course Title

Name o University/Study Centre

Qualifcations eg. BEng, MSc, HNC, etc

Full Time Part Time

I declare that the statements made on this orm are to the best o my knowledge true. I agree to complywith the Royal Charter and Bye-laws and Rules o Conduct o the Institution o Engineering and

Technology (IET) and understand that this is a commitment to behave ethically within my proession. I will

do my best to promote the interests o the IET. I confrm that I have not committed any oence o which

the IET would require me to give notice under its Rules o Conduct. The Rules o Conduct and the Royal

Charter and Bye-laws are published on the website www.theiet.org/byelaws and the Terms and Conditions

o Membership can be ound www.theiet.org/membership-terms

Declaration

Signature

Date d d m m y y y y

Membership Number (only required or previous Associates or Members wishing to re-join the IET):

Subscription Rates

Subscription rates rom 1 January 2013 until 31 December 2013 (Fees correct at time o print and subject to change in January 2014)

Payment can be made by annual Direct Debit or one o Credit/Debit card please complete the relevant section on the enclosed payment orm. Alternatively you can pay by

Sterling cheque/bank drat, please make it payable to the Institution o Engineering and Technology and write your name and address on the reverse.

20or 1 year 50or duration o coursePlease tick appropriate box

V1.0

Start Date End Datem m y y y y m m y y y y

Part-time Postgraduate Students Subscription Rates

I you are a part-time postgraduate student you are not eligible or student membership. However, you can apply or membership o the IET with

MIET/TMIET designatory letters. Dependent upon your annual income you may be eligible or a reduced ee. The IET reserves the right to veriy your claim.

Title First Name(s)