INDUSTRIAL AFFILIATE APPLICATION FORM / If you require assistance or advice please call Membership Services on:+44 (0)1509 678153
(Please write clearly in block capitals)
A)CompanyContact Details
Company Name
Address
Post Code
Contact No.
Website / VAT Number
Main Contact (This person will be the first line of contact for all calls/correspondence between the Company and IGEM)
Title / Forenames / Surname
Job Title
Address
(if different from above)
Work No. / Mob. No.
B)How do you propose to gain value from your Industrial Affiliation?(please select as many as applicable)
1)Through Business/Organisational2)Through Technical involvement
involvement as follows:as follows:
Business DevelopmentProfessional support/advice
NetworkingInterpreting/accessing/applying
IGEM standards
Attending conferences/eventsPursuing Professional Registration and development of engineers
Sharing of best practice
Gain professional endorsement
3)Other (please explain)
C)Competence to practise technical activities.
Please note that if your company engages in technical activities within the gas industry or you selected any of the boxes section B2, and you wish to become an Industrial Affiliate, IGEM requires information on your access to the appropriate competence to support these activities.
1)Does your company undertake technical activities[1] within the gas industry, including but not limited to, design, operations, training and / or consultancy?
YesIf Yes: please proceed to C2) below;
NoIf No: please proceed to D)
2)Does your company employ or have access to Professionally Registered Engineers and Technicians equivalent[2] to EngC Chartered Engineers, Incorporated Engineers or Engineering Technicians1?
YesIf Yes: please provide details below;
NoIf No: please proceed to C3)
Please provide registration details including Name, Organisational Role in the company, EngC Registration Number and date of birth of the most senior engineer/technicians.
Name / Organisational Role
EngC Reg.No. / Date of Birth
EngC Grade / Chartered Incorporated Engineering Technician
Name / Organisational Role
EngC Reg.No. / Date of Birth
EngC Grade / Chartered Incorporated Engineering Technician
Please proceed to D)
3)Are your technical activities at a level equivalent to UK NVQ Competence Level 3 or above1?
YesNoIf No: please proceed to C4)
If Yes:
You will need to gain access to the services of Professionally Registered Engineers and Technicians equivalent to EngC Chartered Engineers, Incorporated Engineers or Engineering Technicians1 in order to meet the requirements for membership as an Industrial Affiliate.
Please complete these details in section C2).
P/04/12–V2
4)Do you have access to individuals who hold technical competence awards equivalent to UK NVQ Level 2 or above[3]?YesNo
If Yes:
Please provide details of name, awards held and organisational role in your company of the individuals concerned. Please also send copies of the certificates.
Name / Organisational role
Awards
Name / Organisational role
Awards
Name / Organisational role
Awards
If No:
You will need to gain access to the services of individuals who hold technical competence awards equivalent to UK NVQ Level 2 or above1 in order to meet the requirements for membership as an Industrial Affiliate. (for further information, please contact membership services)
D)Confirmation of Agreement
Please describe your company and confirm your agreement to the paragraph below by entering your company name:
______being part of the Gas Industry or having interests or activities in connection with the Gas Industryapplies for election as an Industrial Affiliate of the Institution of Gas Engineers & Managers and agrees that if so elected, will be bound by the Royal Charter and By-Laws of the Institution of Gas Engineers & Managers.
E)Size of your Organisation/Company?
1 - 5 employees
6 - 15 employees
16 - 99 employees
100 - 499 employees
500+ employees
F)Your Industry Sector(s)(please select as many as applicable)
Transmission and Storage / Other
Distribution Services
Installation Pipework
Meter Installation
Equipment and Appliances: Domestic
Equipment and Appliances: Industrial
Equipment and Appliances: Commercial
Education Sector
Manufacturer
Utilisation
Regulatory Body
Consultancy
Exploration and Production
Nominated Representatives (Please refer to the guidance notes for the number of representative(s) entitled)
Representative 1
Are you an IGEM Member? / YesNo
Title / Forenames / Surname
Address / Post Code
Work No. / Mob. No.
Job Title / Email
Representative 2
Are you an IGEM Member? / YesNo
Title / Forenames / Surname
Address / Post Code
Work No. / Mob. No.
Job Title / Email
Representative 3
Are you an IGEM Member? / YesNo
Title / Forenames / Surname
Address / Post Code
Work No. / Mob. No.
Job Title / Email
Representative 4
Are you an IGEM Member? / YesNo
Title / Forenames / Surname
Address / Post Code
Work No. / Mob. No.
Job Title / Email
Representative 5
Are you an IGEM Member? / YesNo
Title / Forenames / Surname
Address / Post Code
Work No. / Mob. No.
Job Title / Email
G)Additional Contacts
HR Contact
Title / Forename / Surname
Job Title / Email / Work No.
Marketing Contact
Title / Forename / Surname
Job Title / Email / Work No.
Finance Contact
Title / Forename / Surname
Job Title / Email / Work No.
H)How did you hear about IGEM? (please select)
Technical Standards / IGEM Website / IGEM Event
ag
Trade Show / IGEM Gi / Other
I)Company Directors (continue on separate sheet if necessary)
Name / Position
Name / Position
Name / Position
Name / Position
Name / Position
J)Payment Details
Grade of Membership / Application Fee / VAT
Industrial Affiliate / £100.00 / £20.00 (UK Only)
PLEASE NOTE: Upon successful election Membership Services will write to you requesting the remaining Membership Subscription Fees.
I wish to pay by:
Debit/Credit Card (Please complete the payment section below)
Cheque (Please make payable to ‘IGEM’ and write your Company Name on the reverse)
Card No. / / / / / /
Expiry Date / / / 3 digit Security No.
Cardholders Name
K)Declaration (to be completed by the Main Contact Representative)
The named contact(s) is/are nominated to act as representative(s) of:
(Company Name)
In all matters relating to their membership of the Institution of Gas Engineers & Manager and agree that he/she/they will be bound by the Royal Charter and By-Laws of the Institution.
Name
Signature / Date
Please note: If we have not received all fees due within 3 months of notification of your application being accepted the offer of membership will be withdrawn and you will need to re-apply.
Data Protection
IGEM is licensed under the Data Protection Act to hold the data you provide solely for purposes of maintaining your membership and to provide you with appropriate benefits. As a service to you we will send you information regarding IGEM events, services and products that may be of professional interest to you. Your information will also be given to the Section representative who may contact you regarding events in your area. If you would prefer not to receive emails from IGEM please tick this box
INDUSTRIAL AFFILIATE APPLICATION FORM
GUIDANCE NOTES
Section C2) List of equivalent affiliated institutions:
If you do not have access to Engineering Council registered professionals, but do have access to Engineering Technicians, Incorporated Engineers or Chartered Engineers who are registered with any of the following organisations, we will review the equivalence of their professional registration:
Engineers Australia
Engineers Canada
Chinese Institute of Engineers
The Hong Kong Institution of Engineers
Institution of Engineers India
Persatuan Insinyur Indonesia (Institution of Engineers)
Institution of Professional Engineers Japan
Korean Professional Engineers Association
Institution of Engineers Malaysia
Institution of Professional Engineers NZ
Philippine Technological Council
Association for Engineering Education of Russia
Institution of Engineers Singapore
Engineering Council of South Africa
Institution of Engineers Sri Lanka
Council of Engineers Thailand
"Ordine Degli Ingegneri" National Engineers Council (CNI) - Italy
P/04/12–V2
1 For clarification please consult the IGEM membership team
[2]Please see guidance notes at the end of this form for equivalent affiliated institutions
1 For clarification please consult the IGEM membership team