The Security Institute Application for Student Membership

Student membership is available to anyone studying on a recognised full or part-time

course in a security related subject. For Office Use Only

When submitting this application please include proof of your student status ie: letter ACN:...
from university/course provider; student card etc.

Your first years membership fee (50) must be submitted with this application.

SECTION 1: PERSONAL INFORMATION

Please print or type all information clearly, using a black pen. You may register more than one email address with us, but only one
address for any occasional postal communications.

Surname Forename (s)

Previous Names(s) Known as Title
Date of Birth Place of Birth

HOME ADDRESS
Your home address is used to complete pre-membership checks. If you prefer all postal communication with the
Security Institute to be sent to your HOME address, please tick here. (Double click box and select checked)

Address
Town Post Code
County Country (if not UK)
Telephone

ALTERNATIVE/BUSINESS ADDRESS
You can choose an alternative set of contacts for your post and email eg: Business, term address etc. Please
complete all fields that are relevant. If you prefer all postal communication with the Security Institute to be sent to
your ALTERNATIVE address, please tick here. (Double click box and select checked)

Company Name
Nature of Business
Job Title
Address
Town Post Code
County Country (if not UK)
Telephone Mobile

EMAIL ADDRESS (Mandatory)

Preferred Email Address
Alternative Email Address

Security Institute 2016

Application for Student Membership Issued 01.03.2016
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SECTION 2: COURSE DETAILS

Course Title
Course Provider
Study Start/End Dates End Qualification
Tutor Name Tutors Phone
Tutors Email

SECTION 3: DECLARATION
I am applying for student membership of the Security Institute.
The information I have given in this Application is true to the best of my knowledge and belief.
I understand that my Application may be declared invalid and any subsequent membership or affiliation may
be revoked if any of this information is found to be false, inaccurate or intentionally misleading. The Institute
will not be liable for making any refunds in these circumstances.
I understand that the Security Institute may wish to verify some or all of the information provided and I hereby
authorise the Institute or its appointed agents to perform reference checks as required.
I give my permission to the Security Institute to process, file and retain the information that I have provided in
this application. I understand that should my membership cease, this information will be retained for up to 3
years from the date my membership expires.
If I am accepted into the Security Institute, I agree to be bound by its Standards, Rules and Ethics, Articles of
Association and Regulations copies of which are available on the Institutes website https://www.security-
institute.org/About_Us/governance/company_info for the time being in force.
I undertake to advise the Institute of any changes to my personal contact details and professional
circumstances.
I undertake to pay any dues promptly, and understand membership may be withdrawn if payment is not
made.

DATA PROTECTION ACT 1998

The information requested in this form has been solicited to enable the Security Institute to process your application,
to verify the information contained therein and to provide you with an ongoing membership service. Communications
concerning governance together with our monthly eNewsletter are a core part of your membership and are essential in
order that we can keep you informed about key Institute activities.
We would also like to send other information which we consider may be of interest to you and to enable you to gain as
much as possible from your membership this will include information on forthcoming events, requests for
information to help us to improve our membership services and other relevant timely information which we consider
may be of value to you. Please tick this box if you do not wish to receive these communications:
Our preferred method of communication is via email, however occasionally we may wish to send postal mailings. In
order to do this efficiently we may seek to engage a company to undertake the mailing on our behalf. Please tick this
box if you do not consent to the Security Institute disclosing your postal address to an engaged 3 rd party for this purpose:

The Security Institute will protect the information which you have provided and will ensure that it is not disclosed to any
individual or organisation not authorised to see it. The Security Institutes full Privacy Policy can be found at:
https://www.security-institute.org/privacy

Signed: Date:

Applications sent via email are deemed to have been signed once submitted to the Security Institute for processing.

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Application for Student Membership Issued 01.03.2016
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How did you find out about the Security Institute? (Please mark appropriate box)

Existing Member If yes, please provide members name

Editorial or Publication Website/Search Engine Training/Qualification
Via RCSP Employer Recommendation SyI Members Event

Exhibition/Event Other (Please specify)

SECTION 4: SUBMITTING YOUR APPLICATION

Please send your completed application (email or paper), including all attachments (scans or photocopies) to:
The Validation Board Registrar
The Security Institute
1 The Courtyard
CALDECOTE
Warks CV10 0AS or info@security-institute.org

PAYMENT of your first years annual subscription fee (50.00) must be submitted with your membership application. We accept
payment by cheque, BACS, and credit/debit card.

The Membership Year runs from 1st of the month following membership confirmation, and annual subscriptions fees are payable on
the anniversary of this date. Failure to pay annual subscription fees when required will invalidate membership.

PAYMENT CONFIRMATION
REMITTANCE ADVICE

Cheque: This should be made payable to The Security Institute and sent to: 1 The Courtyard, Caldecote, Warwickshire,
CV10 0AS

BACS: Please ensure that your name is quoted as your BACS payment reference. Our bank details are The Security
Institute, Account Number 10539381, Sort Code 090222, BIC: ABBYGB2LXXX, IBAN: GB36 ABBY09022210539381

Credit/Debit Card: Payment can be made online via our website http://www.security-institute-shop.org Payment is made
at the time of purchase through PayPal, and you can instantly print out your own receipt. Alternatively you may complete the
details below.

Expiry Date Security Code

Start Date (Maestro/Solo cards only Issue No (Maestro/Solo cards only

Card Holders Name (as it appears on the card)

First line of address at which card is registered
If preferred, please telephone through card information to our head office on: 08453 707717 (within the UK)
or +44 2476 346464 (from outside the UK)

Security Institute 2016

Application for Student Membership Issued 01.03.2016
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