Surname / Last / Family name: First names:
Date of birth (DD / MM / YY): Title (Mr / Mrs / Ms etc):
BCS membership no (if applicable):
Home details
Address:
Town/City:
Telephone:
Work details
Organisation name:
Postcode:
Telephone (mobile):
Department:
Country:
Address:
Town/City:
Telephone:
Contact email:
Postcode: Country:
Preferred mailing address (please tick): Home Work
Alternative email:
Your work experience
Your current/most recent job title:
Your Open Group Certification
To apply for CITP status you will need to send us this application with an authenticated copy of your Open Group certificate.
Please tell us which valid Open Group certification you hold and are using to support this application:
The Open Group Certified Architect:
Master (level 2)
Distinguished (level 3)
The Open Group Certified IT Specialist:
Master (level 2)
Distinguished (level 3)
An authenticated copy of my certificate is included/attached
Please note: Your Open Group certificate must have at least 6 months validity from the date of your application for CITP status.

Payment details and method of payment
Existing BCS members: You will need to pay an application fee. The CITP membership subscription will be payable on your normal membership renewal date after you have been successful in achieving CITP status.
Non BCS members: If you are not a member of BCS you will need to pay a CITP membership subscription as well as an application fee.
For our latest fees please visit www.bcs.org/membership/fees
Cheque
Please make cheques payable to BCS and send with your completed application to our Membership Department at the address below.
Credit/Debit card
Once your application form has been received, we will contact you with details of how to make your payment by credit/debit card.
Alternatively you can contact our Customer Services team by telephone: +44 (0) 1793 417 424.
Communicating with you
We recognise that your privacy is important to you.
We will use the information you give us to provide BCS services to you, conduct market research and advise you about other products or services which may be of interest to you.
Your information will be kept securely and we will not disclose this to any third parties without your permission, unless we are required or permitted by law or other court order.
Full details of our data protection and privacy policies are online at www.bcs.org/privacy. You can opt out of emails from us at any time by contacting our Customer Service team by email www.bcs.org/contactus or by phone: +44 (0) 1793 417 424.
Declaration
I wish to be considered for award of Chartered IT Professional (CITP) status and understand that if I am not already a member of the
Institute that this application also constitutes an application for Professional membership.
On admission to membership of the Institute I agree to being governed and to comply with the Institute’s Charter, Bye-Laws and
Regulations from time to time in force and will abide by the BCS Code of Conduct from time to time in force.
Signature: Date:
If you are returning your application by email and are unable to sign it, please tick the box below to indicate your agreement to the declaration.
I agree to the declaration
Once completed please return to:
BCS The Chartered Institute for IT
Membership Department First Floor Block D North Star House North Star Avenue Swindon SN2 1FA United Kingdom
Tel: +44 (0) 1793 417 424 Fax: +44 (0) 1793 417 444 Email: processing@hq.bcs.org.uk Website: www.bcs.org
© The British Computer Society (Registered charity no. 292786) 2012
01371/M/FORM/0312