<p> Application to join Nutritionists in Industry Membership</p><p>April 2017 – April 2018</p><p>Membership of the Nutritionists in Industry group is open to any individual working as a registered nutritionist (or associate) or dietitian (Health Professionals Council) in the food, drink or pharmaceutical industry. Freelancers, who meet the membership criteria, are eligible to join but are asked to provide details of their industry clients. </p><p>The cost of membership is £40 (1 year) </p><p>You will be asked a series of questions below in order for us to assess your suitability for membership. Please complete all questions and print in block capitals (feel free to attach your business card). </p><p>Title: Miss/Ms/Mrs/Mr/Dr (delete as applicable) First Name(s): ...... Surname: ...... Job Title: ...... Company: ...... Address this is my work address personal address ...... Postcode ………………………………... Work/daytime telephone (including code): ...... Mobile phone (optional): ...... Preferred e-mail address: ...... </p><p>Nutrition Qualifications (please state degree title, year and university): ...... What year did you start working as a nutritionist within the food industry?...... </p><p>Are you a (please tick):</p><p>Registered Nutritionist Associate Nutritionist Registered Dietitian</p><p>Are you a member of (please tick): British Dietetic Association The Nutrition Society</p><p>Please detail any other relevant professional memberships: ...... </p><p>Which of the following best describes your job? (Please tick one) Employed within a company Freelance - please list companies worked for over the last two years ...... If you work for a company, what type of company is it? (Please tick)</p><p>Retailer Food manufacturer Clinical Nutrition Food supply Infant nutrition Health Promotion Charity Trade association Other ………………………</p><p>Which department within your company are you based? Please tick</p><p>Nutrition R&D Sales & Marketing Communications/corporate affairs Regulatory affairs Technical/science Other ………………………….. If you are a freelance nutritionist, what is your main area of work? Please tick</p><p>Nutrition R&D Sales & Marketing Communications/corporate affairs Regulatory affairs Technical/science Other …………………………..</p><p>A list of NII members, their e-mail address and phone number(s) are maintained on the NII website to enable networking. This list can only be viewed by members. Please indicate by marking in the box if you do not want your details to be appear on the NII website.</p><p>Do not use my e-mail address and daytime telephone number/mobile phone number on the Nutritionists in Industry website. </p><p>Signed………………………………………….. Date ………………………………</p><p>Please send your completed application form: </p><p>By Post: Rachel Bradford, Membership Secretary and Treasurer NII, 10 Oak Close, Chiddingfold, Godalming, Surrey, GU8 4SA</p><p>By e-mail: [email protected]</p><p>Your payment of £40 </p><p>By Cheque: Make payable to “Nutritionists in Industry” and send to above address</p><p>By direct bank transfer:</p><p>Account Name Nutritionists In Industry Sort code 20-91-79 Account Number 10213330 Bank Barclays Reference Please use your Surname and Initial(s)</p><p>Please note we cannot accept credit card payments or issue invoices.</p><p>We endeavour to send confirmation of your membership, along with a payment receipt, within two weeks of the receipt of your application and payment. </p><p>If you have any queries of if your contact details change, please contact [email protected] or [email protected] *The NII membership year runs from April 5th until April 4th.</p>