Application for Membership
Fax No: +44 (0)20 7401 2817
Surname
First Names
Style (Captain, Mr, etc.)
Employer
Position
Date of Birth
Nationality
Postal Address
Tel. No
Fax No
Mobile
E-mail
Certificate of
Competency
held
Number
Where Issued
Date of Issue
Basis on which issued:
By Exam:
College
attended
Dates
By Previous Certificate: Type
Number
Where issued
Date
Photocopies of Certificates specified above must be attached.
* Professional Experience including date of first command (where appropriate)
If Pilot: Licensing Authority
Date
** Degree: Type & Subject
University
Year of
Graduation
* Officers joining under the command criteria must include a photocopy of their Continuous Discharge Certificate(CDC) book  to verify their sea time, rank and ship size.
** Graduates must supply written evidence of their employment and a copy of their degree.
Signed
Date
Joining Instructions
Please complete and return this application form together with required documentation,
joining fee and first year's subscription either by cheque or credit card to:
The Nautical Institute, 202 Lambeth Road, London, SE1 7LQ, UK.
On receipt, your application will be considered by Council's Membership Committee.
All cheques should be made payable to: The Nautical Institute.
Card Type: Switch Issue No.
Card No: Expiry Date:
Name of Cardholder:
Company
Name:
(If Applicable)		 Start Date:
(If Applicable)
Signed Date
Please tick box if you require:
A receipt
A Direct Debit form
(UK bank account holders)
Bank transfer details
Please tick if you wish us to charge future subscription fees to your credit card
(If the subscription rate changes, a notice will be sent in advance)

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