A password will be e-mailed to you.
Please use capital letters and ensure that you provide all the required information. You must check the information before submitting it. We must stress that it is crucial that you complete this application correctly. Incorrect completion of this form may lead to your membership application being delayed or rejected.
SIU MEMBERSHIP APPLICATION
Your Name (required)
Your Surname (required)
Select your gender (required)
Date of Birth, DD/MM/YYYY format only. (required)
Contact Number (required)
Please Type your e-mail again (required)
Address Line1 (required)
Please select your County (required)
Click hereOverseasAvonBedfordshireBerkshireBordersBuckinghamshireCambridgeshireCentralCheshireClevelandClwydCornwallCounty AntrimCounty ArmaghCounty DownCounty FermanaghCounty LondonderryCounty TyroneCumbriaDerbyshireDevonDorsetDumfries and GallowayDurhamDyfedEast SussexEssexFifeGloucestershireGrampianGreater ManchesterGreater LondonGwentGwynedd CountyHampshireHerefordshireHertfordshireHighlands and IslandsHumbersideIsle of WightKentLancashireLeicestershireLincolnshireLothianMerseysideMid GlamorganNorfolkNorth YorkshireNorthamptonshireNorthumberlandNottinghamshireOxfordshirePowysRutlandShropshireSomersetSouth GlamorganSouth YorkshireStaffordshireStrathclydeSuffolkSurreyTaysideTyne and WearWarwickshireWest GlamorganWest MidlandsWest SussexWest YorkshireWiltshireWorcestershire
Please select your Country (required)
Click hereEnglandWalesScotlandNorthern IrelandOverseas
Postcode - Please provide this in correct format i.e. E8 5UB, NN10 1AB (required)
Please select the membership you are applying for (required)
Select your choice here1) Standard Monthly Paid £12.50 - Recurring Payment Monthly2) Premium Monthly Paid £31.25 - Recurring Payment Monthly3) Executive Worldwide Monthly Paid £175 - Recurring Payment Monthly4) Standard Discounted Monthly Paid £10 - Recurring Payment Monthly5) Standard Annually Paid £120 (20% OFF / was £150) - Recurring Payment Yearly6) Premium Annually Paid £187.50 (50% OFF / was £375) - Recurring Payment Yearly7) Executive Worldwide Annually Paid £1,950 - Recurring Payment Yearly8) Standard Discounted Annually Paid £75 - Recurring Payment Yearly9) Premium Medic Monthly Paid £99+£35 - Recurring Payment Monthly10) Premium Medic Annually Paid £375 - Recurring Payment Yearly11) Platinum Medic Monthly Paid £149+£43 - Recurring Payment Monthly12) Platinum Medic Annually Paid £499 - Recurring Payment Yearly13) WageProtection™ Monthly Paid £1 - Recurring Payment Monthly14) Student Annually Paid £12 - Recurring Payment Yearly
Please select the payment method for your membership (required)
Select your choice here1) PayPal2) Direct Debit3) BACS4) Standing Order
Are you the payment account holder? (required)
Select your choice here1) Yes, I am the account holder2) No, I am not the account holder
Has the account holder fully authorised you to make and set up the payments? (required)
Select your choice here1) Yes, I am authorised by the account holder2) No, I am not authorised.
Where did you hear about us?
If you have been referred by an existing member, please enter his/her full name.
Your feedback for SIU
Do you have a code that has been given by an existing SIU member? Please enter the code below:
YOU MUST READ THE FOLLOWING NOTICE
1) When you submit this form, you will receive a confirmation email from us. Sometimes, depending on your email provider, our email may get caught by spam filters. If you cannot see our email in the inbox, check the spam/junk mail. Please ensure to add @the-siu.org.uk domain as a safe sender, so you can receive our email without any problem in the future.
2) Press ''Send my application'' button only once and allow up to 30 seconds for confirmation of acceptance of your application to appear on your screen. You will also receive an automated email as a receipt for your application.
3) ''Submit my application'' button shall only be activated if you accept the Disclaimers and Terms & Conditions by ticking the individual boxes.
I certify that, all information provided in my application is true and correct to the best of my knowledge.
I accept that I will be charged on a recurring basis as per my selected membership subscription until I cancel in writing.
I accept that SIU member benefits are discretionary and I will only be eligible for member benefits under my selected membership category.
I understand that my personalised membership card will be delivered to my address within 14 days and in the interim I can access to SIU member benefits as normal. I have viewed SIU Member Benefits Access Guide.
I understand that for non-urgent enquires I should call 0845 901 1451 ask for a call back or create a ticket on SIU website by clicking SIU Member Support, or e-mail at email@example.com, or call 07960 219439 for urgent assistance, or call pager on 07623 984335 for emergency assistance and leave a brief description to the operator.
END OF THIS FORM