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Membership Form

Personal Details
Title*
First Name*
Other Names
Surname*
Qualifications
Job Title*
Direct Dial Number*
Fax Number
E-mail address*
How did you hear about PIPA?
Other

Company Details
Company Name*
Department Name
Address*
(as per company letterhead)
Town*
County*
Postcode*
Country
Company Telephone Number*
VAT Registration Number
Purchase Order Number

What category of membership are you applying for?*
Associate
Member1
Fellow2
Are you applying to upgrade you membership status?*
Yes No
From Associate to Member1
From Member to Fellow2
Renewing membership or new application?*
I am applying for new membership
I am renewing my membership
Membership Number

For all applicants applying for Member or Fellow status

By submitting this request, you agree to commit to the PIPA continuing professional development scheme for the forthcoming year.

All Applicants
Do you supervise other staff or manage your information unit?
Yes No

1. Send a copy of your current CPD card, covering at least the last two years, to the PIPA Administrator. In the email header or text indicate that it is being submitted to support an application for Member status. If you already have a PIPA membership number, include that in the email header.

2. Send a copy of your current CPD card, covering at least the last two years, plus a copy of your current CV, to the PIPA Administrator. In the email header or text indicate that it is being submitted to support an application for Fellow status. If you already have a PIPA membership number, include that in the email header.

Note: To comply with data protection requirements, all documents submitted to support a membership application will be deleted once your application has been processed.