Apply Online - Irish College of Physicists In Medicine

Membership Application Form

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"*" indicates required fields

Membership Category*

Please select one of the following:

Pre-registration Member

Expert Member

For pre-registration members:

Before you start to fill out the form below, please make sure you have the following documents to hand as you will asked to upload them as part of your application:

Proof of ID - copy of passport or driving license (certified by an authorised person)
Evidence of your undergraduate degree (certified by an authorised person)
Evidence of your postgraduate degree (certified by an authorised person)
Training certificate as evidence of approved training programme OR detailed CV outlining equivalent work experience
Evidence of current work as a clinical medical physicist (using this form)
Letters of support from two ICPM members/fellows (using this this form)

For expert members:

Before you start to fill out the form below, please make sure you have the following documents to hand as you will asked to upload them as part of your application:

Proof of ID - copy of passport or driving license (certified by an authorised person)
Evidence of your undergraduate degree (certified by an authorised person)
Evidence of your postgraduate degree (certified by an authorised person)
Training certificate as evidence of approved training programme OR detailed CV outlining equivalent work experience
Evidence of additional advanced experience training in clinical medical physics - 3 years of CPD points matched to the competencies in RP174.
Evidence of current work as a clinical medical physicist (using this form)
Letters of support from two ICPM members/fellows (using this this form)

Specialist Area*

Please select one of the following:

Diagnostic Radiology and Imaging Physics

Therapeutic Applications of Ionising Radiation

Clinical Diagnostics and Therapeutics

Personal Details

Title*

First Name*

Last Name*

Date of Birth*

Proof of ID*

Please upload proof of ID - copy of passport or driving license (certified by an authorised person)

Max. file size: 2 MB.

Work Details

Job Title*

Grade*

Employer/Company*

Evidence of Current Work*

Upload evidence of current work as a clinical medical physicist (using this form)

Max. file size: 2 MB.

Undergraduate Education

To become a pre-registration member of the ICPM, you MUST have an undergraduate honours degree (or equivalent) in the physical sciences suitable for membership of the Institute of Physics (IOP).

Select which of the following you have:

To become an expert member of the ICPM, you MUST have an undergraduate honours degree (or equivalent) in the physical sciences suitable for membership of the Institute of Physics (IOP).

Select which of the following you have:

Honours Degree (level VIII) in Physics from a recognised university in Ireland or from an institution accredited by the Institute of Physics (UK)

Enter details below:

Educational Establishment*

Degree Title*

Date Conferred*

Undergraduate Degree (Physics)*

Please upload evidence of your undergraduate degree (certified by an authorised person)

Max. file size: 2 MB.

Honours Degree in a Physical Science, evidenced by eligibility for MPhys status with the Institute of Physics (UK)

Enter details below:

Educational Establishment*

Degree Title*

Date Conferred*

Undergraduate Degree (Engineering )*

Please upload evidence of your undergraduate degree (certified by an authorised person)

Max. file size: 2 MB.

Postgraduate Education

To become a pre-registration member of the ICPM, you must have a postgraduate degree in Medical Physics or equivalent

To become an expert member of the ICPM, you must have a postgraduate degree in Medical Physics or equivalent

Educational Establishment*

Degree Title*

Date Conferred*

Postgraduate Degree*

Please upload evidence of your postgraduate degree (certified by an authorised person)

Max. file size: 2 MB.

Add Another Postgraduate Degree

Educational Establishment*

Degree Title*

Date Conferred*

Postgraduate Degree*

Please upload evidence of your postgraduate degree (certified by an authorised person)

Max. file size: 2 MB.

Training/Experience

To become a pre-registration member of the ICPM, you must have one of the following:

To become an expert member of the ICPM, you must have one of the following:

Completed an approved training programme in medical physics (min. 2 years) as per the European recommendations for Medical Physics Expert (MPE)

Approved Training Programme in Medical Physics*

Please upload training certificate

Max. file size: 2 MB.

Demonstrated equivalence in training in your chosen speciality area by providing details of your work experience and Continuous Professional Development (CPD) over a minimum of an initial 2-year period

Demonstrated Equivalence in Training*

Please upload detailed CV

Max. file size: 2 MB.

Advanced Experience Training

To become an expert member of the ICPM, you must have an additional 3 years’ Advanced Experience Training in clinical medical physics.

I confirm that I have 3 years of advanced experience in my chosen speciality, at least 6 months of which has been in Ireland (matched to the competencies in RP174). I will provide proof of same later in the application process.*

Membership of other Professional Organisations

Are you currently a full member of the IOP (Institute of Physics)?

Yes

Are you currently a full member of another organisation?

Yes

Name of Organisation(s)*

Have you achieved State Registration as a Medical Physicist Expert in another EU country?*

Yes

“A medical physicist accepted for registration in another E.U. country having a registration scheme recognised by the European Federation of Organisations of Medical Physics (EFOMP) shall automatically be eligible for membership of ICPM”

Country*

Membership Number*

Date of Registration*

Registration Valid Until*

Please upload a copy of your Medical Physics Expert Registration Certification*

Max. file size: 2 MB.

Experience

If you have not achieved state MPE registration in another EU state please confirm your experience meets the eligibility criteria of the ICPM

I confirm that I have 3 or more years’ experience, post-training, working as a physicist in medicine with responsibility for patient care*

Yes

I confirm that I have maintained a portfolio of Continuous Professional Development and have maintained competency in my chosen field of Medical Physics*

Yes

I confirm that I am currently working as a physicist in medicine with responsibility for patient care*

Yes

Supporters

If you have not achieved state registration in another EU state, please provide letters of support from two ICPM members to back up your application. The letters of support should follow this template

Upload First Supporter*

Max. file size: 2 MB.

Upload Second Supporter*

Max. file size: 2 MB.

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Email Notes To

Username*

Choose a username 6–30 characters long. Your username can be any combination of letters, numbers, or symbols.

Email*

Please enter the email address you'll use for this account.

Data protection information*

I agree to the below

By submitting your membership application or renewal to the ICPM you are providing express consent to the use of your personal data by us for the expressed lawful purpose for which it was gathered. All personal data is stored securely and in compliance with the ICPM’s statutory and regulatory obligations. The ICPM does not disclose any personal data to third parties. Where there is a requirement to confirm membership of the ICPM to any prospective employer on behalf of a candidate who is a member, the ICPM will confirm membership without disclosure of any further information. Your express consent to this confirmation of membership is a condition of membership. The ICPM will only disclose membership to authorised personnel in the Human Resources Department of a Company who confirms their data compliance in writing.

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New Member

Yes

This is to differentiate legacy members and new members

Phone

This field is for validation purposes and should be left unchanged.