IIAI - Grandfather Rights Application

ASSISTED ELECTION SCHEME:

APPLICATION FOR ASSOCIATE MEMBERSHIP (AMIIAI) OR
FULL MEMBER (MIIAI)

PERSONAL DETAILS:

Title (Mr: Mrs: Doctor: etc):

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Forename/s:

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Surname:

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Date of Birth:(dd\mm\yyyy)

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Address Line 1:

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Address Line 2:

Town or City:

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County:

Country:

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Post Code / Zip:

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Telephone: (please supply at least one landline number)

Home:

Email:

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Be sure to add info@iiai.org.uk and info@neucom.eu.com to your allowed lists. Other than Neucom Ltd for IIAI purposes, we do not share information.

I am applying for:

ASSOCIATE membership AMIIAI (£45)

FULL membership MIIAI (£65)

Employment:

Employers Name and Address:

Position /Job Title (or usual title if between jobs):

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Work Phone:

Work Email:

ASSOCIATE Member Applicants agree to this part:

I understand that this grade is designed to recognise those who have commenced the development of basic investigative skills under supervision at work; and/or, those who require a basic understanding of the process in order to assist or fulfill other roles.

FULL Member Applicants complete this part:

I hereby declare at least three years (continuous or cumulative) experience as an accident investigator or that I have had that length of exposure to a relevant aspect of the investigative process. As bullet points or key points (i.e. concisely), the level of experience or exposure that I will rely upon is as follows.

Title/s of any qualification, Certificate, Diploma, Degree etc that you would like recorded with your membership details. If you are a member of any Institutes or the Engineering Council please put designatory letters only:

Referees:

Names and contact details of two referees who would support this application if needed (we will only contact referees in exceptional circumstances and only with your permission):

STATEMENT:

I have read,understood and agree to abide by the Institute’s Code of Conduct.

As far as I am able to ensure, the information I have provided is true and accurate. I understand that knowingly providing false or misleading information, or failing to advise the Institute of such once it is known to me or suspected, could nullify this application.

I can supply further information to support this application if needed.

Should my application be unsuccessful, monies paid will be refunded to me in full.

I understand that as a Full Member of the Institute I....
May use the designatory letters AMIIAI or MIIAI after my name in keeping with the grade to which I have applied and been elected.
Will receive a membership certificate that remains the property of the Institute at all times.
Will receive a membership card.
Will have free access to the members only on-line forum (subject to the terms there).
Will have access to the members only password protected reading area.

As soon as it resumes...
Will receive free, or have access to, the quarterly e-bulletin.
Will be able to call the Institutes authorised help-line (subject to the terms there).

Please read this if you are an Associate Member applicant:
I understand that the assisted election scheme for Associate Members requires me to complete the on-line IIAI Foundation Certificate in Industrial Accident Investigation and Analysis and I agree to comply with that requirement. I will not be charged for that course and I am aware that I will receive a credit for completing it that will stay on my record or be identified on a higher level award should I later complete one. I understand that the on-line course is in English and that non UK members should compare any cited legislation with the rules or laws where they live and/or work. The password to access and complete the course will be supplied to me along with my membership certificate, card and welcome letter and the on-line examination for the course does not effect either this application or my election.

Please read this if you are a Full Member applicant:
I understand that the assisted election scheme for Full Members gives me the option to complete the on-line IIAI Foundation Certificate in Industrial Accident Investigation and Analysis free of charge. I will consider that option. I will not be charged for that course and am aware that I will receive a credit for it should I opt to complete it. That credit will stay on my record or be identified on a higher level award should I later complete one. I understand that the on-line course is in English and that non UK members should compare any cited legislation with the rules or laws where they live and/or work. The password to access and complete the course will be supplied to me along with my membership certificate, card and welcome letter and the on-line examination for the course does not effect either this application or my election.

Date: *

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Name: *

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