UKMPA Application Form - United Kingdom Maritime Pilots Association

Full Name:

Full Address:

Town:

County:

Postcode:

Date of Birth:

Phone Number:

Email Address:

Port (District)/ Company:

Position Title (IE. Pilot):

Membership Category:

Requested UKMPA Joining Date:

A current member must be named as proposer to validate joining application

Proposer: Name & Port
(A1, A2 & Trainee only)

As part of our quality procedures and to gain a better understanding of our member's competencies
please complete the following in the space provided

Highest Professional Qualifications Held (IE. STCW certification/ Degree or Diploma):

Career Experience (Briefly list any relevant seagoing experience, port or maritime work starting with the latest first including positions held and dates appointed):

Upload Your CV:

Please provide the following information to help us speed up your application. A Direct Debit mandate will be issued in advance of any payments being taken

Bank Name:

Bank Full Postal Address:

Name(s) of account holders:

Account Number:

Sort Code:

Data Protection: I agree that my membership details including email address, telephone number and postal address will be held on a computer database solely for the purposes of club administration and communication, will not be shared with any outside organisation other than those directly associated with UKMPA membership requirements and will be deleted when my membership is discontinued. I can withdraw consent at any time, and can also request that contact details are not available on the private / members section of the website.

By ticking this box I give express consent for the UKMPA to hold my personal data within a secure CRM system, solely for the administration of UKMPA business and the distribution of notices and circulars to members. The UKMPA will never pass your information to third parties. You can cancel your membership of the UKMPA at anytime and request your data is permanently deleted - membership@ukmpa.org
By ticking this box I give express consent for the UKMPA to hold my personal data within a secure CRM system, solely for the administration of UKMPA business and the distribution of notices and circulars to members. The UKMPA will never pass your information to third parties. You can cancel your membership of the UKMPA at anytime and request your data is permanently deleted - membership@ukmpa.org

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application to join UKMPA