Application Application for Membership Application for Membership All fields must be completed Salutation NoneDrRevMrMrsMs First Name Other Name(s) Surname Birthdate Date01020304050607080910111213141516171819202122232425262728293031MonthJanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecemberYear201020092008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930192919281927192619251924192319221921192019191918191719161915191419131912191119101909190819071906190519041903190219011900 Country of Citizenship E-mail Address Postal Address 1 Postal Address 2 Suburb State/Province/County Postcode Country Professional Membership Area Applying For (e.g. General Management Profession) Education History: Use format – Qualification, institute, Location, Date (You must email certified copies of your qualifications to CIPPRO) Employment History: Use format – Position held, Company, Start date, End date. (NOTE: After listing your work history, please state in capital letters the profession that you want membership for. For example: GENERAL MANAGEMENT PROFESSION, etc) Membership Applying for: (Select the Membership from either Individual or Corporate categories Individual Membership DFCIPP Distinguished Fellow Member of the Chartered Institute of Practising Professionals FCIPP Fellow Member Chartered Institute of Practising Professionals AFCIPP Associate Fellow Member of the Chartered Institute of Practising Professionals MCIPP Member of the Chartered Institute of Practising Professionals ASCIPP Associate Member of the Chartered Institute of Practising Professionals ASCIPP Affiliate Student Member of the Chartered Institute of Practising Professionals Corporate Membership DFCCIPP Distinguished Corporate Fellow Member of the Chartered Institute of Practising Professionals CFCIPP Corporate Fellow Member of the Chartered Institute of Practising Professionals CAFCIPP Corporate Associate Fellow Member of the Chartered Institute of Practising Professionals CMCIPP Corporate Member of the Chartered Institute of Practising Professionals CASCIPP Corporate Associate Member of the Chartered Institute of Practising Professionals CAMCIPP Corporate Affiliate Member of the Chartered Institute of Practising Professionals Terms & Conditions: CIPP Application Terms & Conditions 1.If your application to join CIPP is not successful, the joining fees that you have paid will be refunded 2.You are not entitled to a refund after your application has been assessed and approved 3.CIPP members are required to pay their annual membership fees 4. As soon as your application is approved by the CIPP you are entitled to describe yourself as a Chartered Practising Professional (CPP) 5. In sending this application to CIPP, I declare that: (i) I agree to indemnify and hold harmless CIPP for activities performed by CIPP and/or its associates, subordinates, affiliates and employees (ii) I agree that I shall indemnify and hold harmless CIPP and their associates, subordinates, affiliates and employees against any and all loss, damage, or liability (whether civil or criminal) suffered as a result of any of my own activities and/or decisions (iii) I am satisfied with the fact that the Chartered Institute of Practicing Professionals is a registered private professional body that outstanding professionals anywhere in the world can belong to. Since CIPP is a registered private organization, with members in various parts of the world, I am satisfied with the fact that the officers/board members of the CIPP are specifically invited and appointed to their CIPP positions by the CIPP President. This model of appointment enables the President to invite high calibre people into the CIPP Board of Management (iv) I agree to abide and follow CIPP code of practice that requires CIPP members to: Pursue excellence Act with integrity Be honest and trustworthy and never deliberately mislead Be open and transparent in all professional activities Engage in additional training to enhance your professional capabilities Avoid discrimination of any kind Have the courage to make a stand on matters of principle and be prepared to identify and act against malpractice of any sort Maintain confidentiality but be prepared to expose any malpractice or illegal, unprofessional or fraudulent conduct Maintain objectivity at all times, providing fair and appropriate neutral advice Have insurance if required for my profession in my country of operation. I hereby declare that I have read to the above Terms and Conditions. I Agree I do Not Agree