Membership Number (IMarEST Office Use Only):

AFFILIATE APPLICATION FORM

Please return the completed form to: IMarEST, Membership, Aldgate House, 33 Aldgate High Street, London, EC3N 1EN, UK or Scan form & any other documents and email to: membership@imarest.org Need help? See www.imarest.org or contact Membership on Tel: +44 (0)20 7382 2694 email: membership@imarest.org

1. PERSONAL DETAILS Where did you hear about us?

Title: Sex:

Surname:

M F

Forenames: Date of Birth (dd/mm/yyyy):

Nationality: Home OR Business

2. CONTACT DETAILS Please indicate preferred address for correspondence

Home Address: Business Address: Job Title: Name of organisation: Business Address: Postcode: Tel: Mobile: Email:

Country

Postcode: Tel: Email:

Country:

3. DECLARATION
I hereby confirm that the statements made in this application are, to the best of my knowledge and belief, correct. I agree to abide by the IMarESTs Code of Professional Conduct (please see our website for details), to maintain my Continuing Professional Development and to uphold the values and principles of the IMarEST. Signature: _____________________________________________________ Date: ____________________________________ Data Protection Act (1998) I understand that the Institute will hold and use my personal data for administration purposes to keep me informed of its activities and to offer me goods and services provided by, or on behalf of the Institute. I also understand that the data may be transferred to my local branch and to the Engineering Council or similar registering body. I hereby give consent for the Institute to process the data for such purposes.

4. YOUR QUALIFICATIONS
What is your highest academic qualification? Name of educational establishment: Year of Award

5. MEMBERSHIP AND PAYMENT DETAILS (01/10/2011 30/09/2012)

Your payment will be composed of your annual subscription fee and any fees for additional journals. ANNUAL SUBSCRIPTION Affiliate STANDARD RATE 101 GROUP A COUNTRY* 56 GROUP B COUNTRY* 36 YOU PAY

IMarEST Publications & Journals One publication is included in the membership fee however as some of magazines are audited by ABC (Audit Bureau of Circulations www.abc.org.uk) please sign and date below. This is only used to verify that you are taking a magazine as part of your membership.

FREE JOURNAL
Marine Engineers Review (MER) The Marine Scientist Offshore Technology Signature: Signature: Signature:

PICK ONE ONLY

Date: Date: Date:

FREE FREE FREE

YOU PAY

ADDITIONAL JOURNALS
Marine Engineers Review The Marine Scientist Offshore Technology Shipping World & Shipbuilder (SW&SB) Maritime IT & Electronics (MITE) Shipping World & Shipbuilder (Incorporating Maritime IT and Electronics) Journal of Marine Engineering and Technology Journal of Operational Oceanography Journal of Marine Engineering and Technology and Journal of Operational Oceanography Both at Special Price IMechE Proceedings M (IMarEST Members only)

(MEMBER DISCOUNTED RATE/NON-MEMBER RATE)

32/95 24/52 24/52 34/100 28/58 50/90 (UK) 130 (o/seas) 50/120 28/75 65/180 90

TOTAL:

COUNTRY GROUPS * *GROUP A: BRAZIL, BOTSWANA, COLOMBIA, GABON, KAZAKHSTAN, MALAYSIA, MEXICO, ROMANIA, THAILAND, TURKEY, VENEZUELA *GROUP B: ANGOLA, BANGLADESH, CAMEROON, ECUADOR, EGYPT, ETHIOPIA, GAMBIA, GHANA, GUAYANA, INDIA, INDONESIA, JORDAN, KENYA, MALDIVES, MYANMAR, NIGERIA, PAKISTAN, PAPUA NEW GUINEA, PHILIPPINES, SOLOMON ISLANDS, SRI LANKA, SYRIA TANZANIA, UKRAINE, VANUATU, ZAMBIA, ZIMBABWE. Your Payment Prices are correct at the time of printing. To check current prices please visit our website. Alternatively, please indicate that you are happy for any price change to be applied to your application by ticking here

Payment Details
For UK bank holders wishing to pay by Direct Debit send no money now. Enter your Bank or Building Society details in the Direct Debit mandate section below, and return the whole form with your application to the IMarEST. (Note - we cannot accept scanned mandates) The first Direct Debit payment will be collected IN FULL on ONE of the following dates (payments are not spread over the dates): 23rd November 2011, 18th January 2012, 21st March 2012, 23rd May 2012, 18th July 2012, 19th September 2012 The IMarEST will write to you prior to taking any further membership subscription payments, which fall due annually on or around 1 st October. Applications will not be processed until payment has cleared.

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Membership Number (IMarEST Office Use Only):

Instruction to your bank or building Society to pay by Direct Debit Please fill in the form using a ball point pen and send to: Membership, The IMarEST, Aldgate House, 33 Aldgate High Street, London, EC3N 1EN Name and full postal address of your bank or building society To: The Manager Bank/Building Society Address FOR IMarEST OFFICIAL USE ONLY This is not part of the instruction to your bank

Service User Number

Postcode

Bank/Building Society account number

Instruction to your bank or building society Please pay The IMarEST Direct Debits from the account detailed in this instruction subject to the safeguards assured by the Direct Debit Guarantee. I understand that the Instruction may remain with The IMarEST and, if so, details will be passed electronically to my bank/building society Signature(s) Date

Credit or Debit Card VISA MasterCard Amex Debit Card Switch/Maestro card (Issue No. .)

Card No. _ _ _ _ / _ _ _ _ /_ _ _ _ /_ _ _ _ /_ _ _ Expiry date _ _ /_ _ Security number _ _ _ Name on card: (please print)________________________________ Signature: _________________________________ Cheque (please make payable to The IMarEST)

6a. DO YOU CONSIDER YOURSELF TO BE A:

Marine Engineer Marine Scientist Marine Technologist (please tick as appropriate)

6b. GENERAL AREAS OF PRACTICE (Please tick as appropriate)

Commercial Shipping Defence and Naval Engineering Coast & Ocean Mapping & Hydrography Coastal & Shelf Seas Marine Law, Governance & Regulation Oceanography Climatology & Marine Meteorology Underwater Technology & Operations Publishing/Media Societies, Associations & NGOs Ship design, construction, maintenance & decommission Marine Engineering Systems and Equipment Navigation & Communication Fishing, Aquaculture & Biotechnology Marine Renewables Natural Hazards Marine Leisure Recruitment & Manning Other, please state Ports and Harbours Power & Propulsion Marine Environment & Pollution Marine Finance, Insurance & Risk Marine Safety & Security Offshore Oil & Gas Education & Training Research & Consultancy

7. APPLICANTS CHECKLIST
1. 2. 3. 4. Personal details completed Contact details completed Applicants declaration signed Qualifications completed 5. 6. Payment details completed Your choice of journals completed General areas of practice completed

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