Institute of Remote Health Care

Quality Management System

APPLICATION FOR CORPORATE MEMBERSHIP

Please complete the form below to enable the IRHC Membership Committee to assess your application and appropriate grade of membership.

INFORMATION REQUIRED / DETAILS
Name of Organisation
Address
Website
Telephone Number
As an IRHC Corporate Member, please nominate TWO key contacts
in your organisation to receive updates on benefits and activities.
Name
Address
Position within Organisation
Telephone Number
Direct Dial
Mobile
E-mail Address
Please indicate annual turnover, as reported in published accounts for:
Organisation / Whole Group
(if applicable)
Please indicate from the points below the appropriate level of membership:
1 – 15 Employees involved in Remote Healthcare
16 – 25 Employees involved in Remote Healthcare
26 – 49 Employees involved in Remote Healthcare
50 + Employees involved in Remote Healthcare

We hereby apply to be a Corporate Member of the Institute of Remote Healthcare, and if so elected undertake to support the aims and objectives of the IRHC and be bound by the decisions of the IRHC Council as they stand now or may do so in the future.

The named nominated representative should sign and date this application form.

Signature
Print Name
Date

Data Protection Act

The IRHC will hold your personal data on its computer database. This information may be accessed, retrieved and used by the IRHC and its associates for normal administrative purposes. If you are based outside the European Economic Area (the EEA) information about you may be transferred outside the EEA. The IRHC may also periodicallysend you information on membership, training courses, events, conferences and publications which may be of interest.

If you do not want to receive such information please tick this box.

The IRHC would also like to share your personal information with carefully selected third parties in order to provide you with information on other events and benefitsthat may be of interest to you. Your data may be managed by a third party in the capacity of a list processor only and the data owner will at all times be the IRHC.

If you are content for your details to be used in this way, please tick this box.

INFORMATION ABOUT YOUR ORGANISATION

Please complete the form below in order to provide the IRHC with a fuller picture of your organisation. The information will help us offer a wide range of services to benefit our members and plan future activities.

Please tick all that apply.

SECTOR OPERATIONS – What sector does your organisation operate in?
Academia & Schools / Aviation / Biomass
Chemical / Coal / Construction
Consultancy / Electricity / Finance & Legal
Food & Drink / Gas / Geographic Healthcare
Government – Central / Government – Local / Hydro Power
Iron & Steel / Not for Profit/Voluntary / Nuclear
Petroleum / Pharmaceuticals / Pipelines
Quality Control / Retail / Solar Power
Transport & Shipping / Water Power / Wind Power
Other (Please specify)
GEOGRAPHIC OPERATIONS – Where does your organisation operate?
UK / Europe
North America / South America
Africa / Asia
Australasia / Polar Regions
Other (Please specify)
BUSINESS AREAS – What is the nature of your organisation’s business?
Business/Commercial Research & Information / Certification & Quality Assurance / Construction & Decommissioning
Consultancy / Distribution / Drilling
Exploration & Production / Finance & Legal / HSE Management, Inspection, Measurement & Monitoring
Local & Central Government / Maintenance & Installation Management / Marketing
Plant Design & Installation / Procurement / Product Design & Development
Product Manufacture / Refining / Storage
Scientific & Technical Research / Recruitment / Transport/Transmission
Other (Please specify)
CORPORATE MEMBERSHIP BENEFITS - Which of the offered benefits of Corporate Membership do you foresee as being the most useful to your organisation’s operations?
Clinical / Events / Local Branch Activities
Networking & Promotion / Professional Development / Publications & Magazines
Recruitment / Research & Industry Information / Training
Please make any other comments here:

Thank you for taking the time to provide this information.

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Version – v1.0

IRHC/Quality Manual/Corporate Membership/Form 001

Uncontrolled Document