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 from university/course provider; student
etc.

ACN:...
card

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

Date of Birth

Place of Birth

Title

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

MENTORING PROGRAMME
The Security Institute has a free Mentoring Programme for members, partnering them with a
professional experienced in a relevant area of security, to provide guidance and advice on
professional development, career choices and security issues. If you would like someone to
contact you to discuss how to join the scheme, please tick here.
Security Institute 2014
Application for Student Membership
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The Security Institute Application for Student Membership

SECTION 2: COURSE DETAILS
Course Title

Course Provider
Study Start/End
Dates
Tutor Name

End Qualification

Tutors Phone

Tutors Email

SECTION 3: DECLARATION

I am applying for student membership of the Security Institute.

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.

The information I have given in this Application is true to the best of my knowledge and
belief.

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 3rd party for this purpose:

Security Institute 2014

Application for Student Membership
Page 2 of 3

The Security Institute Application for Student Membership

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.

How did you find out about the Security Institute? (Please tick one)
Existing Member
Editorial or
Publication
Via RCSP

Exhibition/Event

SyI Members Event

Website/Search Engine

Training/Qualification

Employer Recommendation

Other

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 (including AMEX).
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

I wish to pay my First Years Annual Subscription Fee of 50 by:

Cheque: This should be made payable to The Security Institute and sent to: 1 The Courtyard, Caldeco
Warwickshire,
CV10 0AS
BACS: Please ensure that your name is quoted as a reference on the BACS details. Our bank
details are The Security Institute, Account Number 83798879, Barclays, 22 The Borough,
Farnham, Surrey, GU9 7NH,
Bank Sort Code: 20-31-06. IBAN: GB33 BARC 2031 0683 7988 79
Credit/Debit Card Payment can be made online via our website http://www.security-instituteshop.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

Security Institute 2014

Application
for Student
Start
DateMembership
(Maestro/Solo cards
only
Issue

Page 3 of 3

No

(Maestro/Solo cards only

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)