ACET Membership Application Form Personal Details Title: Mr Mrs Miss Ms   Reference Number:     First Name/s:* Surname:* Have you ever been known by or used another name?:* Date of Birth:*   Home Address:* Post Code:*   Business Name:*   Business Address:* Post Code:* Telephone (Work):* Telephone (Home): Telephone (Mobile): Fax: Email Address:     Professional Qualifications Qualification: Date Completed: Institution:   Institution Address: Institution Post Code: Employment History Job Title:* How long have you been an IT Professional?* Trade/Employer References (Please provide details of three parties with whom you have had a commercial relationship within the last two years. This can include business premises landlords, clients, contractors, providers and suppliers.) Reference 1: Name:* Job Title:* Company Name:* Company Address:* Post Code:* Phone Number:* Fax Number: Email Address: Reference 2: Name:* Job Title:* Company Name:* Company Address:* Post Code:* Phone Number:* Fax Number: Email Address: Reference 3: Name:* Job Title:* Company Name:* Company Address:* Post Code:* Phone Number:* Fax Number: Email Address: Professional References: (Please provide one of the following: accountant, bank, solicitor) Name:* Job Title:* Company Name:* Company Address:* Post Code:* Phone Number:* Fax Number: Email Address: Insurance Cover (insurance cover is inclusive through Membership and the following information is required) 1. Business Activities a) Do you carry out any business activities other than contract programming, IT consultancy, training or general business consultancy? *   Select Yes No If yes, please provide details: Please continue in a separate email if necessary b) Do you provide any interim management or facilities management services? *   Select Yes No If yes, please provide details: Please continue in a separate email if necessary c) Do you supply any physical product other than computer hardware? *   Select Yes No If yes, please provide details: Please continue in a separate email if necessary d) Are you responsible for any contractors working on any project? *   Select Yes No If yes, please provide details: Please continue in a separate email if necessary e) Do you work on any live trading or mission critical systems? *   Select Yes No If yes, please provide details: Please continue in a separate email if necessary Financial Information a) Was your turnover for the last financial year more than £150,000? *   Select Yes No b) Have you worked on a project in the last 3 years when the total price value exceeded £500,000? *   Select Yes No Additional Information a) Is all of your work carried out under your client's direct instruction? *   Select Yes No If no, please provide details: Please continue in a separate email if necessary b) Is all of your work carried out in the UK for UK clients? *   Select Yes No If no, please provide details: Please continue in a separate email if necessary c) Have any claims or intimations of any shortcomings in your work, in respect to the risk to which these Insurance Cover questions relate, even been made against you? *   Select Yes No If yes, please provide details: Please continue in a separate email if necessary Criminal Record Have you ever been convicted of, or charged with (but not yet tried with), any offence other than motoring? *   Select Yes No If yes, please continue in a separate email giving details. If no, you are required to let the Association know if you are convicted of any offence (other than motoring) in the future. Does the nature of your business solely or predominantly bring you into contact with children and/or vulnerable adults? *   Select Yes No If yes, please continue in a separate email giving details. If no, you are required to let the Association know if you are convicted of any offence (other than motoring) in the future. Declaration I wish to apply for membership of the Association of Computer Engineers and Technicians, ACET. (‘the Association’). I confirm that:              I have read and completed the Application Form. I declare that the contents of this Form are true, that I have not omitted any material information and that all documents accompanying my application are either the originals or true copies thereof. *              I have read and accept the Association’s Terms and Conditions. *              If I have omitted or suppressed any material information, including material information that is relevant to insurance risk, or if any information/documents provided in the application are found to be false, the Membership of the Association and therefore the professional insurance cover will be retrospectively null and void. *              Please indicate how many questions are completed by email: * Please accompany this application with: •  Copies of professional qualifications if applicable •  Copy of passport or driving licence •  Cheque (if chosen method of payment) •  Completed relevant standing order mandate (if chosen method of payment) To: The Association of Computer Engineers and Technicians, Wellington House, East Road, Cambridge, Cambridgeshire, CB1 1BH. Your application will be processed within 21 days. Membership Fees Membership fees can be paid:  •   Annually in advance £765.00 (by debit/credit card, cheque or standing order)  •   Monthly in advance £68.25 (12 payments by debit/credit card or standing order) Method of Payment * Cheque - made payable to the Association of Computer Engineers and Technicians for £765.00 Annual Bank/Building Society Standing Order payable to the Association of £765.00 (Please complete the Bank/Building Society Standing Order Authority) Monthly Bank/Building Society Standing Order payable to the Association of £68.25 (Please complete the Bank/Building Society Standing Order Authority) Annual Credit/Debit Card - Value £765.00 per annum (The Association will contact you shortly to obtain credit/debit card details) Monthly Credit/Debit Card - Value £68.25 per month (The Association will contact you shortly to obtain credit/debit card details)