Associate and Fellow Reinstatement Form

Associate and Fellow Reinstatement Form
1. This form is for reinstatement of membership at the previous level you held.

2. To ensure your application is processed as quickly as possible please ensure that you have correctly completed all sections of this form. Incomplete forms will be returned.

3. Applications made from 1 July will be charged at half the full subscription fee for the current year.

4. By reinstating your membership you are commiting to maintain high professional standards, adhere to our Code of Ethics and terms and conditions of membership.

5. Members are required to pay an administration fee of £25 for reinstatement of a lapsed membership.

For further information or help, please contact membership@libf.ac.uk or call us +44 (0)1227 818609.

Your Details
LIBF Number (if known)
LIBF Number
Title
Name*

First NameMiddle NameLast Name
Previous Name
Please tell us any previous name you have used that would help us link this application to any other records we may hold for you
Date of Birth*

DayMonthYear
Gender*

MaleFemaleOther (e.g. Non- Binary)Prefer not to say

Contact Details
Email*
Preferred phone number
Please enter a valid phone number
Mobile Number if different from above
Please enter a valid mobile number

Address and Employment Details
Job Title (if applicable)
Employer/business name
Address*

Building name/number/street name

Address Line 2

Town/CityCounty/State / Province

Postal / Zip CodeCountry

Membership type
AssociateFellow
Applications made from 1 July will be charged at half the full subscription fee for the current year. Please note an additional administration fee of £25 will be added for reinstatement of membership.

Full Year - £145 +£25Half year if applying after 1 July - £72.50 + £25
Applications made from 1 July will be charged at half the full subscription fee for the current year. Please note an additional administration fee of £25 will be added for reinstatement of membership.

Full Year - £200 + £25Half year if applying after 1 July - £100 + £25

Select Payment Option
Your initial membership payment will need to be made by card, invoice or Bank Transfer - any future renewals can be taken by direct debit
Would you like to set up an annual Direct Debit for future payments?

YesNo
Please select how you would like to make payment*
Total cost

We will email a copy to the email address you provide. By requesting an invoice, you are agreeing to pay this invoice within 30 working days of receipt.
Please enter the details of the invoice recipient.

to myselfdifferent details to those entered above
Employer/business name (if applicable)
Name of Person Invoice needs to addressed too

First NameLast Name
Email for Invoice to be sent
example@example.com
Invoice Reference (Optional)
Purchase order number, cost centre number. This will appear on your invoice.
Address For Invoice if different from your preferred address

Building name/number/street name

Address line 2

Town/CityCounty/State/Province

Post Code/CityCountry

Card Details
First Name	Last Name
Credit Card Number	Security Code
Card Expiration

Direct Debit Instruction For Membership (UK Bank Or Building Society Accounts Only)
Name(s) of Account Holders*
Bank or Building society account number*
Branch Sort Code*
To: The Manager*

Name of Bank or Building Society

Address Line 1

Town/CityCounty

Post Code
Instruction to your bank or building society to pay by direct debit

Service User No 990346

Instruction to your bank or building society
Please pay Walbrook Institute Direct Debits from the account detailed in this instruction subject to the safeguards assured by The Direct Debit Guarantee. I understand that this instruction may remain with Walbrook Institute and, if so, details will be passed electronically to my bank/building society.
Signature*
Date*

DayMonthYear
Date
The Direct Debit Guarantee (This Guarantee Will Also Be Sent By Email So You Have A Copy For Your Records)
The Direct Debit Guarantee

This Guarantee is offered by all banks and building societies that accept instructions to pay Direct Debits
- If there are any changes to the amount, date or frequency of your Direct Debit Walbrook Institute will notify you 10 working days in advance of your account being debited or as otherwise agreed. If you request Walbrook Institute to collect a payment, confirmation of the amount and date will be given to you at the time of the request
- If an error is made in the payment of your Direct Debit, by the Walbrook Institute or your bank or building society, you are entitled to a full and immediate refund of the amount paid from your bank or building society - If you receive a refund you are not entitled to, you must pay it back when Walbrook Institute asks you to
- You can cancel a Direct Debit at any time by simply contacting your bank or building society. Written confirmation may be required. Please also notify us.

Declaration
Your personal data

We will use and protect your personal data in accordance with current data protection legislation to process your application. Further details, including your rights, the disclosure of data to third parties, storage, retention and how to amend your personal data, can be found within our Privacy Notice.

Members will be delivered a digital credential / badge through our third party arrangement with Credly.

Our Terms and conditions, along with our Code of Ethics provides a framework of professional conduct for members.
Declaration - you must agree and accept the below to continue:

By registering you declare that the information you have entered is true and accurate, consent to the processing and use of your personal data as outlined in the Privacy Notice.I agree to abide by LIBF Code of Ethics.I accept the Terms and Conditions.
Signature*
Please sign to confirm you have read and agreed to the declaration above. A digital signature is acceptable
Should be Empty:

Account Name:	Walbrook Institute London Limited
Account Number:	10514632
Sort Code:	20-18-00
International Bank Account Number (IBAN):	GB83 BARC 2018 0010 5146 32
SWIFTBIC (Bank Identifier Code):	BARCGB22
Bank Address:	Barclays Bank plc, East Kent Gp9, Leicester LE87 2BB

Associate and Fellow Reinstatement Form

The Direct Debit Guarantee (This Guarantee Will Also Be Sent By Email So You Have A Copy For Your Records)