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Full June 15
Personal Details:
Title First Name
Surname Date of Birth
Membership Number (if already a member) Email
Full Employer/Organisation Name
If you are not currently a member of IEMA or any of your details have changed, please complete the sections below.
NB. All future correspondence will be sent to this address.
Correspondence Address
Town
County
Postcode
Country
Mobile Telephone
Home Telephone
Business Telephone
Job Title
IEMA has a policy to ensure no candidate is disadvantaged during assessment. If you have any special requirements that may affect
your application, please enclose details in a covering letter to accompany your application. Please note that you must disclose any
special requirements at the start of the application process. Anything not disclosed at this time cannot be relied upon later.
1
Membership and Registration
Tick Fee
Existing Member of IEMA applying for Full Membership/Dual/CEnv 415.00
I am a current IEMA Full Member and wish to achieve CEnv status 415.00
I am not a Member of IEMA and would like to join as an Affiliate and Full/Dual/CEnv 532.00
I have CEnv status through another professional body and wish to achieve IEMA Full
311.00
Membership and can then transfer my CEnv status should I require
Declarations
I confirm that I have read and understood the criteria and application guidance for IEMA
Full Membership and CEnv and believe I fulfil the requirements.
Signature: Date:
By signing your name on this form, you confirm that the information supplied is complete and accurate and
you understand that your application or resulting qualification/membership may be withdrawn at a later date if
the information is found and proved to be false and/or misleading. Membership and registration fees are non-
refundable. Incomplete applications will not be accepted.
NEXT STEPS
1. Complete this form and supporting documents, ensuring you sign and date it and that the
required number of copies are included.
2. Return the form and supporting documents, in person, to an IEMA member of staff or
alternatively post it to the IEMA Membership Team at: IEMA, City Office Park, Tritton Road,
Lincoln. LN6 7AS UK.
3. Payment must be received in order to process your application. Please complete the
payment details section.
2
CODES OF PRACTICE
As a Full Member of IEMA I will: As a Chartered Environmentalist I will:
Uphold and promote the environment and sustainability Act in accordance with the best principles for the
profession; mitigation of environmental harm and the enhancement
of environmental quality;
Signature: Date:
3
Witnesses
Two witnesses are required to verify that the paper submitted is both a fair and representative
account of the candidates experience in relation to the criteria for Full Membership.
Witnesses cannot be the applicants IEMA mentor. Examples of a witness include line manager, colleague
and/or client.
One or both witnesses should have an environmental/
sustainability background and it is preferable but not Original copies of witness statements are preferred
compulsory if at least one is an IEMA Full and/or Chartered however scanned copies are accepted.
Environmentalist member.
Verified that the supporting paper, CV and other information provided in this application is a
fair representation of the candidates skills and experience.
Witness one
Name
Job Title
Employer
Professional Qualifications
(e.g. MSc, MIEMA, CEnv etc.)
Relationship to candidate
Address
Telephone
Email
Signature: Date:
Witness two
Name
Job Title
Employer
Professional Qualifications
(e.g. MSc, MIEMA, CEnv etc.)
Relationship to candidate
Address
Telephone
Email
Signature: Date:
4
Payment Details:
Please tick your preferred payment method. Please note that fees are non-refundable. If you would prefer to pay for your
registration by credit or debit card over the telephone, please submit your application and supporting documents and tick the box
below. It is not necessary to make 4 copies of the payment details section. Receipts are automatically emailed once payment
has been taken.
Signature Date