Application for Affiliate Membership

Applications from 1 July 2014 to 30 June 2015

For office use only
Date received:

Ackn. date:

MRM:

Membership number:

PLEASE REFER TO THE GUIDANCE NOTES ON THE REVERSE

OF THIS FORM BEFORE COMPLETING YOUR APPLICATION
1

Section 1 Personal details

Title: Mr

Mrs

Miss

Ms

Dr

Prof

Other
Home address:

Family name:
First names:
Date of birth:

M M

Town:

Email:

County/State:

Mobile:

Postcode:

Telephone:

Country:

Section 2 Business details

Employer name:

Address:

Job title:

Town:
County/State:

Email:

Postcode:

Telephone:

Country:

Industry sector Please tick (/) one box only

Accountancy & Business Services

Food & Drink

Pharmaceuticals

Advertising, Media & PR

Gas/Electricity/Utilities

Property, inc. Social Housing

Broadcasting

Healthcare

Publishing

Central Government

Hospitality/Sports

Other Public Sector

Construction

Human Resources/Recruitment

Regulatory

Consultancy

Information Technology

Retail & Wholesale

Education/Training

Insurance

Risk Management Services Firm

Engineering/Electronics

Legal Services

Transport/Logistics/Shipping

Environmental & Waste Services

Local Government

Travel/Leisure

Farming, Forestry & Rural

Manufacturing

Telecommunications

Financial Services/Banking

Natural Resources/Gas/Oil/Mining

Voluntary/Charity/Not-for-profit

Other please state

Page 1 of 6

Section 3 Mailing information

Please tick (/)

Preferred postal correspondence address: Home Business
Preferred email correspondence address:

Home Business

Section 4 Qualifications and experience

Please complete all relevant sections and attach copies of any relevant certificates.
DETAILS OF QUALIFICATION HELD
(Examinations and/or awarding body)

DATE
OF AWARD

DOCUMENTARY
EVIDENCE SUPPLIED

RISK MANAGEMENT EXPERIENCE

NAME OF EMPLOYER

DATES

JOB TITLE

I attach a copy of my current CV

Section 5 Fees payable

FEES

RATE

PERIOD

Joining fee

Standard rate &

Low GDP rate*

90

Payable by all applicants

Annual subscription
For members applying between
1 July 2014and 31 March 2015

Standard rate
Low GDP rate*

101
86

Covers membership up to
and including 30 June 2015

For members applying between

1 April 2015 and 30 June 2016

Standard rate
Low GDP rate*

130
110

Covers membership up to
and including 30 June 2016

*Low GDP rate This applies to applicants living in a country with a low GDP. Please refer to IRMs website for a list of eligible countries.

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Section 6 Payment

I wish to make payment of the following fees:

Joining fee

90
State amount
to be paid

Annual membership subscription

TOTAL

Section 7 Payment method

Please select (a), (b), (c) or (d)

(a) Bank transfer

Bank transfer - Please ensure that your name is quoted as a reference
IRM Bank transfer details
Bank name: Lloyds TSB

Sort code: 30-93-23

Account number: 00748112

Account holders name: Institute of Risk Management

Branch: Fenchurch Street Branch

IBAN no: GB46LOYD30932300748112

Swift code: LOYDGB21009

(b) Cheque
Cheque attached

Cheque to follow

(c) Credit card

For details of how to pay by credit card please telephone us on +44 (0) 20 7709 9808.
You are strongly advised not to send credit card information by email.

(d) Invoice

Please tick (/) if you require an invoice to be sent to your employer. A copy will also be sent to you for your records.

Purchase Order Number

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Section 8 Data Protection and Privacy

Data protection and privacy

IRM will ensure your personal data is processed in line with Data Protection legislation and IRMs Data Protection and Privacy Statement
(available on the IRM website). In submitting this application you are deemed to have consented to IRM processing your data.
Sharing your data with third parties
IRM will never sell or share your data to third parties for commercial gain. We may conduct postal mailings on behalf of
third parties on a commercial basis where we think the service will be of interest to you. IRM will assume that you consent to
us using your data in this way, unless you tick this box.
Sharing information with your employer
IRM will, upon request, provide your employer with details of your IRM examination record and accreditation, including
all attempts and future entries, unless you tick this box.
Privacy and electronic communications regulations
IRM may, from time to time, wish to draw your attention to other IRM products and services electronically which are
likely to be of interest to you. IRM will assume you consent to us using your data in this way unless you tick this box.

Membership promotion information

Please tick (/) to show where you heard about IRM.

Friend or colleague

IRM letter/flyer

Internet
search engine

Press article

Employer

Other
Please specify

IRM website
IRM magazine

(Risk Management Professional)

IRM conference/event
Careers advisor

Section 9 Declaration

ADMISSION TO MEMBERSHIP
I hereby apply for admission as an Affiliate of the Institute of Risk Management. I certify that the information supplied on
this form is correct and I declare that:
I have read and agree to abide by IRMs Code of Conduct.
I accept IRMs terms and conditions.
I understand that if my application is successful IRM reserves the right to publish my name.
I understand that I am not entitled to use any IRM designatory letters.

Signed

Date

THANK YOU FOR YOUR APPLICATION. WE LOOK FORWARD TO WELCOMING YOU AS A NEW AFFILIATE.

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APPLICATION GUIDANCE NOTES

We have prepared these guidance notes to help you with
your application. Please read them before completing the
application form as any errors may delay your application.

CANCELLATIONS AND WITHDRAWALS SUBMISSION

Please refer to IRMs website for full details of our terms and
conditions.

SECTIONS 1 AND 2 PERSONAL AND BUSINESS DETAILS

Please complete these sections in full.

When you have completed your application form please send it to:

SECTION 3 MAILING INFORMATION

Important member services, including passwords to the
member-only pages of our website are delivered exclusively
by email. If you do not express a preference we will use your
business email address.
SECTION 4 QUALIFICATIONS AND EXPERIENCE
Please complete all the relevant sections and attach copies of
certificates as evidence of your qualifications and attach an
up-to-date version of your CV.
SECTION 5 FEES PAYABLE
All applicants are required to pay a one-off joining fee
and the appropriate annual subscription. The Institutes
subscription year runs from 1 July to 30 June. If you are
applying for membership after 31 March in any year you
will be required to pay a proportion of the current years
annual subscription plus the full amount for the following
years annual subscription. You will be invited to renew your
membership subscription on an annual basis.

Member and Student Services

Institute of Risk Management
2nd Floor
Sackville House
143-149 Fenchurch Street
London
EC3M 6BN
T +44 (0)20 7709 9808
F +44 (0)20 7709 0716
E enquiries@[Link]
W [Link]
[Link]
OR email it to: membership@[Link]
We look forward to receiving your application form.

SECTIONS 6 AND 7 PAYMENT AND PAYMENT METHOD

Please note that full payment should accompany your
application form. If your employer is paying your fees and
requires an invoice, please indicate this on the form. Please be
aware, however, that your application will not be processed
until full payment is received. All fees are payable to the
Institute in Pounds Sterling unless otherwise agreed.
SECTION 8 PERSONAL INFORMATION
Data protection: The Institute takes data protection very
seriously. This section outlines how we use information and
offers you the opportunity to decline information about nonmembership related products and services. We will respect
your preferences, which you can update online at any time.
You can also unsubscribe from IRM emails at any time by using
the unsubscribe option at the bottom of our emails.
Membership promotion: It is helpful to us to know how you
heard about the Institute.
SECTION 9 DECLARATION
Code of Conduct: At the end of the application form you
are required to sign a declaration. Your application cannot
be processed if you do not sign this declaration. Part of
the declaration is that you agree to abide by the Institutes
Code of Conduct. The purpose of IRMs Code of Conduct is
to sponsor and support the highest ethical and professional
standards in risk management worldwide. Please note that
failure to comply with the Code may result in disciplinary
action.
A copy of the Code of Conduct can be found on the final page
of this application form.

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IRM CODE OF CONDUCT

The Institute of Risk Management (IRM) aims to sponsor and
support the highest ethical and professional standards in risk
management worldwide.
The Code
1 The Board of Directors and membership of the IRM require
you as a member to uphold the standards set out in Parts
1 and 2 of the Code and to maintain the good reputation
of IRM by implementing and observing the following
requirements.

1.1 To behave with integrity in your professional life and to

treat those with whom you have contact in a fair and
respectful manner, and without discrimination;

1.2 To observe all relevant laws and the requirements of

regulatory authorities, codes of practice and codes of
conduct within your jurisdiction. This means not only
working within the law, but within the spirit of the law;

1.3 To deal with regulators in an open and co-operative

manner and in accordance with their requirements;

1.4 To have proper regard for public health, safety and the
environment;

1.5 To give fair and proper consideration and appropriate

priority to all the interests and requirements of
colleagues, employees, employers and clients;

1.6 To obtain and provide when requested, clear

information and documentation that is relevant to
the request, and to respect the confidentiality of such
information and documentation unless otherwise
required by law;

1.7 To act at all times with skill, care and diligence;

1.8 To act only within the limits of personal competence and
any limits of authorisation;

1.9 To act with fidelity and in an honest and prudent

manner, and to ensure the protection of property,
including money, entrusted to you by clients;

1.10 To ensure that any activities or actions, and any

promotions or other public announcements with which
you, your name or qualifications are associated do not
bring IRM or your colleagues into disrepute whether
through your actions in work or outside work;

1.11 To ensure that your membership of IRM is not publicised

in any way as to imply the possession of any professional
qualification that you do not hold;

1.12 To ensure, where possible and within your authority,

that those who work for you have appropriate training,
education and supervision; otherwise you should
encourage employees to meet this requirement.

All members must comply with paragraphs 1.1 to 1.12, and failure
to do so in any respect may result in disciplinary proceedings in
accordance with Articles 46 to 50 of IRMs Memorandum and
Articles of Association.

The additional code for Fellow, Member, Specialist, Graduate and

Certificant title holders
2 Those members who are entitled to use one of the above
descriptive titles have additional responsibilities to IRM
and to risk management worldwide.

2.1 you are required to continue your professional

development by whatever appropriate means in order
to ensure that your technical knowledge does not fall
below the required standard;

2.2 you must comply and be able to provide evidence of

compliance with the requirements of IRMs scheme of
continuing professional development;

2.3 you must ensure that IRM is promptly advised of any

change in your circumstances which might affect your
entitlement to continue using your descriptive title;

2.4 you must not use the descriptive title which is granted to
you as an individual member in connection with firms,
partnerships or corporate bodies.

Descriptive title holders must comply with paragraphs 1.1 to

2.4 and failure to do so in any respect may result in disciplinary
proceedings.
The guide to good practice for all members
3 The guide to good practice amplifies but is not part of the
Code.

3.1 members should take every opportunity to improve their

professional capability;

3.2 members should support IRM activities;

3.3 holders of descriptive titles should encourage others to

obtain their professional qualification and should help
promote education in IRM;

3.4 members should be aware of internationally accepted

standards in risk management, including the Risk
Management Standard and any associated or succeeding
documents, and where practicable, implement the
principles therein;

3.5 members are encouraged to share knowledge in order

to promote the advancement of risk management on an
international basis.

Institute of Risk Management

2nd Floor
Sackville House
143-149 Fenchurch Street
London
EC3M 6BN
April 2011

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