Institute of Physics and Engineering in Medicine

Application for

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IPEM Full Membership

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If you are transferring please enter your membership number

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(including
department)

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Register, please state which:

Confirmation of Education and Training

I have asked the following IPEM Fellow, Member or my line manager to verify my education and training certificates.

Title
Name
Email
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if applicable
Document Number:
Version Number:

0048
06.00

Page 1 of 2
(03-06-01)

Issue Date: November 2014

Revised by: Office
Original Issue Date: 22-10-2003

Institute of Physics and Engineering in Medicine

Page 2

Application for
IPEM Full Membership

Check List
I have:
Signed the application form (below)

Enclosed the Report of Training and Experience

Enclosed verified copies of educational and training certificates

Declaration
I wish to apply for Membership of the Institute of Physics & Engineering in Medicine and declare that the information I
have given in this application is, to the best of my knowledge, accurate and true. I agree to be governed by the Rules of
IPEM, including its Code of Professional Conduct, and accept that any breaches of the Rules or the Code of Professional
Conduct will be dealt with under IPEM's Disciplinary Procedure.
Signature

Date

If you are also a member of the Institue of

Physics (IOP) you are entitled to 25% discount
on your membership fee. Please state your
IOP membership category:

Your IOP Registration

Number:

When applying for Full Membership you can request further information about the following Awards:
Full details will be sent to you via email.
CEng or
RSci
CSci or

Please sign and send completed form to:

Print Form

IEng

Membership Department, IPEM, Fairmount House, 230 Tadcaster Road, York, YO24 1ES
or email to office@ipem.ac.uk