Student Membership Application Form

* Indicates required information

Section 1 - About Yourself

Surname (Family Name)*

First Name*

Title*

Home Address*

Town*

County*

Post Code*

Home Telephone No

Email Address*

Sex (Male/Female)*

Date of Birth*
(dd/mm/yyyy)

All correspondance will normally be sent to your home address unless otherwise stated. Should you wish your correspondence to be directed to your term address please tick the box below and give the address details in the area provided.

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Name of College/University*

Address*

Course Title*

Qualification Studying*

Course Duration*

Expected Completion Date*
(dd/mm/yyyy)

Section 2 - About Your Previous Education

Course Title

Educational Establishment

Qualifications received with grades

Section 3 - Sponsor (Course Supervisor)

Course tutor name*

Position Held*

Address*

Length of time applicant known to sponsor
*

Section 4 - Declaration

I declare that the information contained in this application form is correct and hereby apply to be elected the class of STUDENT member of the Chartered Institution of Wastes Management and I undertake if elected to conform to the Articles, Byelaws and Regulations of the Institution as at present formed, or as they may be hereafter altered, amended or enlarged. I further undertake to pay the entrance fee and the annual subscription prescribed, and to promote the objects & aims of the Institution as far as may be in my power.

Tick here*

Name*

Date*

© 2011 Chartered Institution of Wastes Management (CIWM)
IWM Business Services Limited (IWMBS) is a wholly owned trading subsidiary of CIWM and provides certain products and services on behalf of CIWM.
CIWM is a company incorporated by Royal Charter, registered in England No. RC000777; and is a charity registered in England and Wales (1090968) and in Scotland (SC037903)
IWMBS is a company registered in England and Wales No: 2731563

Registered Offices: 9 Saxon Court, St Peters Gardens, Northampton, NN1 1SX, United Kingdom

Student Membership

Student Membership Application Form

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