Institute of Corrosion, Barratt House, Kingsthorpe Road, Northampton, NN2 6EZ

TEL: +44 (0) 1604 438222

E-mail: Website:

APPLICATION FOR INDIVIDUAL MEMBERSHIP 2018/2019

(Please TYPE or PRINT in black ink)

Mr/Mrs/Miss/Ms/Dr/Prof SURNAME / FORENAMES (in full)
DESIGNATORY LETTERS / e.g. BSc, CEng, MIMF / Date of Birth
PRIVATE ADDRESS
including postcode
EMPLOYER / Date of Joining
APPOINTMENT HELD
BUSINESS ADDRESS
Including postcode
TELEPHONE/ EMAIL / Mobile / Business
Home / Email
Please tick box if you consent to receiving information from the Institute of Corrosion by email. 
Which Address Do You Want To Use For Correspondence And The Journal / Home/Business
You are welcome to participate in the activities of any Branch and Division and for mailing purposes, you will be allocated to the Branch covering your home location unless requested otherwise. Which Branch and Division do you wish to join? (please indicate)
Branch: / Aberdeen / London / North East / North West / Yorkshire / Midlands
Division(s) / Corrosion Engineering / Corrosion Science
DECLARATION:
I hereby confirm that I have an interest in the practice of corrosion technology and/or science and undertake to comply with the Institute of Corrosion’s Articles of Association and Bye-laws.
Please note that the Institute of Corrosion is GDPR Compliant and we do not hold any data that is not required for the running of the organisation. The Institute of Corrosion Data Protection Manual & Data Protection Policy can be found on the ICorr Website
Signed: ...... Date: ………………………………......
Members with sufficient qualifications and/or experience and training may wish to apply to become Technician/Professional Members, please visit our Website for further details and application form.
FEES (see membership subscription rates schedule)
Registration fee: / £15.00
Individual Membership to 30 June 2019 / £78.00
Corrosion Management by airmail - £30.00 – Please add to total if required
PAYMENT ADVICE
EITHER I enclose cheque/money order payable to Institute of Corrosion for / GB £ ______
OR please debit my Credit/ Debit card (Please note we do not accept American Express)
Name on Card / Expiry date / Security 3 digit No
Card Number
Signed / Date