Referee Details Title: Surname Forename Home Address Town County Postcode Professional Email Length of time known Employer Position Professional Qualification Member of Professional Institute or Body Date: Referee’s Signature Undertaking: I, the undersigned applicant, do hereby accept that in the event of my election I shall be governed by the Articles of the Nuclear Institute, including the NI, Engineering Council and/or Science Council codes of conduct. I accept as final and binding the decisions of the Board of Trustees and will promote the objects of the Institute as far as may be in my power. I accept responsibility for the accuracy of the statements herein. On resignation, of which 6 months’ notice shall be given, I promise to pay all dues, cease describing myself as a member and return my membership certificate. I understand that the information contained in this form will be processed in accordance with the data protection principles in the 1998 Data Protection Act Commitment to continuing my professional development: I agree to maintain records of my Continuing Professional Development and submit these on request by the Nuclear Institute within 3 months of this request. Tick this box to opt in of online Registers Tick this box to opt in of all publicity of successful membership and/or registration Date: Applicant’s Signature
Referee Details Title: Surname Forename Home Address Town County Postcode Professional Email Length of time known Employer Position Professional Qualification Member of Professional Institute or Body Referee’s Signature Date: Undertaking: I, the undersigned applicant, do hereby accept that in the event of my election I shall be governed by the Articles of the Nuclear Institute, including the NI, Engineering Council and/or Science Council codes of conduct. I accept as final and binding the decisions of the Board of Trustees and will promote the objects of the Institute as far as may be in my power. I accept responsibility for the accuracy of the statements herein. On resignation, of which 6 months’ notice shall be given, I promise to pay all dues, cease describing myself as a member and return my membership certificate. I understand that the information contained in this form will be processed in accordance with the data protection principles in the 1998 Data Protection Act Commitment to continuing my professional development: I agree to maintain records of my Continuing Professional Development and submit these on request by the Nuclear Institute within 3 months of this request. Tick this box to opt in of online Registers Tick this box to opt in of all publicity of successful membership and/or registration Applicant’s Signature Date:
MF1_Application_Membership_and_Direct_Fellow_R10.docx