Level Chief Executive/Director Senior Middle Junior

Sector

Job Role

Further information about you and your career

For CILIP to implement its Equal Opportunities Policy we would appreciate it if you could provide the following information.It will be kept strictly confidential and only be used to compile statistics.

I am: Female Male I consider myself disabled: Yes No

Credit/debit card: Please debit myVISA, MasterCard or Maestro

Card number:

Name on card:

Expiry date: / Start date: / Issue no. Maestro only:

Card security code (last 3 digits on signature panel):

Cheque or postal order for the full amount. Make cheques payable to CILIP.

Invoice my employer for the full amount. (Payment must be made within 30 days of the date of the invoice).

Email the invoice to: Purchase order number:

Address the invoice to Name:

Address:

Postcode:

OR

OR

OR

Bank Sort Code:

Name of account holder(s):

Account Number:

SIGNATURE(S):

The Manager: Bank/Building Society (full address of your branch):

Postcode:

Instruction to your bank or building societyPlease pay CILIP Direct Debits from the account detailed inthis Instruction subject to the safeguards assured by the DirectDebit Guarantee. I understand that this Instruction may remainwith CILIP and, if so, details will be passed electronically to mybank/building society.

Membership number/Reference:

Service User Number: 724249

Direct Debit Instruction

CILIP: 7 Ridgmount Street,London WC1E 7AE

Please tick ONE of the following payment options:

Direct Debit: I would like to pay by Direct Debit: in a single payment or in 10 instalmentsPlease complete the Direct Debit Mandate form below.

Archivist/Records ManagerIndependent ConsultantInformation ProfessionalIT/Web

Knowledge/Information ManagerLearning Resources ManagerLibrarianLibrary Assistant

Library Manager

Other:

CommercialFurther EducationGovernmentHealth

Higher EducationIndustry/ScienceLawNational Libraries

Not For ProfitPrisonPublicPublic - Children/Youth

School

Other:

I would describe my ethnic origin as:

White - Welsh / English / Scottish / Northern Irish / British Irish Gypsy or Irish TravellerAny otherWhite background (please state)

Mixed/multiple ethnic groups - White and Black Caribbean White and Black African White and AsianAny other mixed/multiple ethnic background (please state)

Asian/Asian British - Indian Pakistani Bangladeshi ChineseAny other Asian background (please state)

Black/African/Caribbean/Black British - African CaribbeanAny other Black/African/Caribbean background (please state)

Other ethnic group - ArabAny other ethnic group (please state)

CILIP Updatemagazine &journals

Professionaldevelopment& qualifications

Careers advice& support

Advocacy &campaigning

Special deals& discounts

MEMBERSHIPAPPLICATION FORM

2013

Join CILIP and receive...

www.cilip.org.uk/member

Networkingopportunities

New_Mem_2013(AW).qxp:Layout 1 14/12/12 11:21 Page 1

Rate Earnings or Category Subscription Direct DebitBand Instalment

(10 instalments)

T More than 17,501 194 19.40

I 14,001 - 17,500 160 16.00

J 12,001 - 14,000 130 13.00

K 10,001 - 12,000 107 10.70

L 8,001 - 10,000 79 7.90

M 5,001 - 8,000 53 5.30

N Less than 5,001/unwaged 38 3.80

O Student members 38 3.80

R Retired members 70 7.00

OV Overseas members 70

MEMBERSHIP APPLICATION FORM

S - Academic & Research LibrariesAD - Aerospace & DefenceC - Branch & Mobile LibrariesA - Career DevelopmentD - Cataloguing & IndexingI - Commercial, Legal & Scientific InformationF - Community, Diversity and EqualityG - Education LibrariansH - Government Information GroupN - Health LibrariesAB - Information LiteracyQ - Information ServicesJ - International Library & Information

L - Library & Information HistoryU - Library & Information ResearchM - Local StudiesB - Multimedia Information & TechnologyX - Patent & Trade MarkK - Personnel,Training & EducationW - Prison LibrariesO - Public LibrariesV - Publicity & Public RelationsP - Rare Books & Special CollectionsR - School LibrariesY - UK e-InformationT - Youth Libraries

Please complete in BLOCK CAPITALS and send this form with your payment to: CILIP, 7 Ridgmount Street, London WC1E 7AE

Your contact details:

Title (please tick): Mr Mrs Ms Miss Dr Other:

Forenames: Surname:

Date of birth: / / Academic qualifications (i.e. postnominal letters):

Home address:

Postcode: Country:

Home telephone: Home email:

Job title:

Work address (or place of study if student):

Postcode: Country:

Work telephone: Work email:

Student only: Name of course/Graduate trainee scheme employer:

Course /trainee scheme finish date: / /

Tick this box if you do not wish to receive emails about CILIP activities.

Tick this box to opt out of receiving administrative emails from CILIP about your membership.

Where would you like to receive correspondence from CILIP?

Preferred postal address Home Work Preferred email address Home Work

How did you hear about CILIP membership: University Colleague Advert Mailing

Exhibition/Conference Website Other (please specify)

Your membership

Have you previously been a member of CILIP, the Institute of Information Scientists, or the Library Association?Tick which category of membership you are applying for.

Associate Affiliate Student Overseas Chartered (Re-instating members only)I hereby apply to be elected or re-instated as a member of CILIP for a 12 month period in the category indicated. I will be boundby the provisions of CILIPs Royal Charter and its current and future byelaws.

Signed: Date: / /

Your Branch and Groups

Choose your special interest groups by ticking the appropriate boxes in the table below.The first two groups are free; you can join others for 10 per group. Further information about groups is available atwww.cilip.org.uk/specialinterestgroups

This Guarantee is offered by all banks and buildingsocieties that accept instructions to pay DirectDebits.

If there are any changes to the amount, date orfrequency of your Direct Debit CILIP will notify youten working days in advance of your account beingdebited or as otherwise agreed. If you request CILIPto collect a payment, confirmation of the amount anddate will be given to you at the time of the request.

If an error is made in the payment of your DirectDebit by CILIP or your bank or building society youare entitled to a full and immediate refund of theamount paid from your bank or building society.

If you receive a refund you are not entitled to, youmust pay it back when CILIP asks you to.

You can cancel a Direct Debit at any time by simplycontacting your bank or building society.Writtenconfirmation may be required. Please also notify us.

How much does it cost?

Pick your subscription rate depending on your annual salary. Pay by Direct Debit and split your subscription in teninstalments. If you are a UK taxpayer you can claim back the tax on your subscription.

Which category should I join?

Anyone can join CILIP. If you are joining for the first timeyou can join in one of two categories Associate orAffiliate. If you are not sure which category applies to you,read our category checklist:www.cilip.org.uk/categorychecklist

Join as an Associate if

You have a CILIP accredited qualification OR anotherqualification and work experience at a professional level.

Join as an Affiliate if

You do not have a degree level qualification and have workexperience at a para-professional level. If you are not sure ifyou have worked at a para-professional level read throughour category checklist: www.cilip.org.uk/categorychecklist

Students

Students welcome at a reduced rate (band O).

Branches and Groups

We will assign you a regional Branch according to yourpreferred correspondence address.

Contact usEmail: membership@cilip.org.ukTelephone: +44 (0)20 7255 0600Textphone: +44 (0)20 7255 0505Fax: +44 (0)20 7255 0501

MembershipCILIP7 Ridgmount StreetLondon WC1E 7AE

Direct Debit Guarantee:

Subscription

Payment for extra groups

Total amount payable

Payment band letter: (see table above):

Your payment details

New_Mem_2013(AW).qxp:Layout 1 14/12/12 11:21 Page 3

Rate Earnings or Category Subscription Direct DebitBand Instalment

(10 instalments)

T More than 17,501 194 19.40

I 14,001 - 17,500 160 16.00

J 12,001 - 14,000 130 13.00

K 10,001 - 12,000 107 10.70

L 8,001 - 10,000 79 7.90

M 5,001 - 8,000 53 5.30

N Less than 5,001/unwaged 38 3.80

O Student members 38 3.80

R Retired members 70 7.00

OV Overseas members 70

MEMBERSHIP APPLICATION FORM

S - Academic & Research LibrariesAD - Aerospace & DefenceC - Branch & Mobile LibrariesA - Career DevelopmentD - Cataloguing & IndexingI - Commercial, Legal & Scientific InformationF - Community, Diversity and EqualityG - Education LibrariansH - Government Information GroupN - Health LibrariesAB - Information LiteracyQ - Information ServicesJ - International Library & Information

L - Library & Information HistoryU - Library & Information ResearchM - Local StudiesB - Multimedia Information & TechnologyX - Patent & Trade MarkK - Personnel,Training & EducationW - Prison LibrariesO - Public LibrariesV - Publicity & Public RelationsP - Rare Books & Special CollectionsR - School LibrariesY - UK e-InformationT - Youth Libraries

Please complete in BLOCK CAPITALS and send this form with your payment to: CILIP, 7 Ridgmount Street, London WC1E 7AE

Your contact details:

Title (please tick): Mr Mrs Ms Miss Dr Other:

Forenames: Surname:

Date of birth: / / Academic qualifications (i.e. postnominal letters):

Home address:

Postcode: Country:

Home telephone: Home email:

Job title:

Work address (or place of study if student):

Postcode: Country:

Work telephone: Work email:

Student only: Name of course/Graduate trainee scheme employer:

Course /trainee scheme finish date: / /

Tick this box if you do not wish to receive emails about CILIP activities.

Tick this box to opt out of receiving administrative emails from CILIP about your membership.

Where would you like to receive correspondence from CILIP?

Preferred postal address Home Work Preferred email address Home Work

How did you hear about CILIP membership: University Colleague Advert Mailing

Exhibition/Conference Website Other (please specify)

Your membership

Have you previously been a member of CILIP, the Institute of Information Scientists, or the Library Association?Tick which category of membership you are applying for.

Associate Affiliate Student Overseas Chartered (Re-instating members only)I hereby apply to be elected or re-instated as a member of CILIP for a 12 month period in the category indicated. I will be boundby the provisions of CILIPs Royal Charter and its current and future byelaws.

Signed: Date: / /

Your Branch and Groups

Choose your special interest groups by ticking the appropriate boxes in the table below.The first two groups are free; you can join others for 10 per group. Further information about groups is available atwww.cilip.org.uk/specialinterestgroups

This Guarantee is offered by all banks and buildingsocieties that accept instructions to pay DirectDebits.

If there are any changes to the amount, date orfrequency of your Direct Debit CILIP will notify youten working days in advance of your account beingdebited or as otherwise agreed. If you request CILIPto collect a payment, confirmation of the amount anddate will be given to you at the time of the request.

If an error is made in the payment of your DirectDebit by CILIP or your bank or building society youare entitled to a full and immediate refund of theamount paid from your bank or building society.

If you receive a refund you are not entitled to, youmust pay it back when CILIP asks you to.

You can cancel a Direct Debit at any time by simplycontacting your bank or building society.Writtenconfirmation may be required. Please also notify us.

How much does it cost?

Pick your subscription rate depending on your annual salary. Pay by Direct Debit and split your subscription in teninstalments. If you are a UK taxpayer you can claim back the tax on your subscription.

Which category should I join?

Anyone can join CILIP. If you are joining for the first timeyou can join in one of two categories Associate orAffiliate. If you are not sure which category applies to you,read our category checklist:www.cilip.org.uk/categorychecklist

Join as an Associate if

You have a CILIP accredited qualification OR anotherqualification and work experience at a professional level.

Join as an Affiliate if

You do not have a degree level qualification and have workexperience at a para-professional level. If you are not sure ifyou have worked at a para-professional level read throughour category checklist: www.cilip.org.uk/categorychecklist

Students

Students welcome at a reduced rate (band O).

Branches and Groups

We will assign you a regional Branch according to yourpreferred correspondence address.

Contact usEmail: membership@cilip.org.ukTelephone: +44 (0)20 7255 0600Textphone: +44 (0)20 7255 0505Fax: +44 (0)20 7255 0501

MembershipCILIP7 Ridgmount StreetLondon WC1E 7AE

Direct Debit Guarantee:

Subscription

Payment for extra groups

Total amount payable

Payment band letter: (see table above):

Your payment details

New_Mem_2013(AW).qxp:Layout 1 14/12/12 11:21 Page 3

Level Chief Executive/Director Senior Middle Junior

Sector

Job Role

Further information about you and your career

For CILIP to implement its Equal Opportunities Policy we would appreciate it if you could provide the following information.It will be kept strictly confidential and only be used to compile statistics.

I am: Female Male I consider myself disabled: Yes No

Credit/debit card: Please debit myVISA, MasterCard or Maestro

Card number:

Name on card:

Expiry date: / Start date: / Issue no. Maestro only:

Card security code (last 3 digits on signature panel):

Cheque or postal order for the full amount. Make cheques payable to CILIP.

Invoice my employer for the full amount. (Payment must be made within 30 days of the date of the invoice).

Email the invoice to: Purchase order number:

Address the invoice to Name:

Address:

Postcode:

OR

OR

OR

Bank Sort Code:

Name of account holder(s):

Account Number:

SIGNATURE(S):

The Manager: Bank/Building Society (full address of your branch):

Postcode:

Instruction to your bank or building societyPlease pay CILIP Direct Debits from the account detailed inthis Instruction subject to the safeguards assured by the DirectDebit Guarantee. I understand that this Instruction may remainwith CILIP and, if so, details will be passed electronically to mybank/building society.

Membership number/Reference:

Service User Number: 724249

Direct Debit Instruction

CILIP: 7 Ridgmount Street,London WC1E 7AE

Please tick ONE of the following payment options:

Direct Debit: I would like to pay by Direct Debit: in a single payment or in 10 instalmentsPlease complete the Direct Debit Mandate form below.

Archivist/Records ManagerIndependent ConsultantInformation ProfessionalIT/Web

Knowledge/Information ManagerLearning Resources ManagerLibrarianLibrary Assistant

Library Manager

Other:

CommercialFurther EducationGovernmentHealth

Higher EducationIndustry/ScienceLawNational Libraries

Not For ProfitPrisonPublicPublic - Children/Youth

School

Other:

I would describe my ethnic origin as:

White - Welsh / English / Scottish / Northern Irish / British Irish Gypsy or Irish TravellerAny otherWhite background (please state)

Mixed/multiple ethnic groups - White and Black Caribbean White and Black African White and AsianAny other mixed/multiple ethnic background (please state)

Asian/Asian British - Indian Pakistani Bangladeshi ChineseAny other Asian background (please state)

Black/African/Caribbean/Black British - African CaribbeanAny other Black/African/Caribbean background (please state)

Other ethnic group - ArabAny other ethnic group (please state)

CILIP Updatemagazine &journals

Professionaldevelopment& qualifications

Careers advice& support

Advocacy &campaigning

Special deals& discounts

MEMBERSHIPAPPLICATION FORM

2013

Join CILIP and receive...

www.cilip.org.uk/member

Networkingopportunities

New_Mem_2013(AW).qxp:Layout 1 14/12/12 11:21 Page 1