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Membership Application Form

Note:
* Please click here to view numbered instructions for each item, or by moving your mouse over the question mark icon.
* Fields marked with * are mandatory
* If your membership is rejected, your application fee will not be refunded


User Name / Password
(Choose your Username and password on application. Once accepted, your User Name cannot be changed. Your password can be changed once your application is accepted)
Username*    
Password* Confirm Password*
 
(1) Application Type*
Type Application Fee Annual Subscription
International Member $ 0 $ 250
Member $ 500 $ 500
Associate Member $ 500 $ 500
 
Special Offer

[Special Offer: Please enter the name of your Association and any membership ID in the next "International Members" Section.]
 
(2) International Members 
Institute Membership ID
Membership Class    
I agree to Mudara IOD accessing Personal Data relevant to my membership from my local Director's Institute.
 
(3) Membership of a Mudara IOD affiliate 
 
(4) Personal Details 
Title* Surname*
First Name* Alias
Gender* Marital Status*
Date of Birth*  (yyyy-mm-dd) Nationality*
Passport Number* Mudara IOD or other
IOD Course Completed / Passed
Educational Qualification*
 
  Subject(s)
 
(5) Personal Contact Details At least one entry is compulsory.
Phone Mobile
Fax Email*
 
(6) Business Contact Details
Organization Name Business Nature
Department Job Title
Telephone Fax
Email    
 
(7) Postal Address
P.O.Box / Postal Code Address
City Emirate / State / Province
Country    
 
(8) Preferred Contact Options
Preferred Phone Contact:
Preferred Email Contact:
 
(9) General Details
How did you hear about the Mudara IOD?
 
(10) Referee 1 Referee 2
Full Name
Organization Name
Job Title
Telephone
Email
Relation to Referee
Full Name     
Organization Name
Job Title
Telephone
Email
Relation to Referee
 
(11) Preferences*  Tick all applicable statements.
Information that helps me perform my role more effectively Opportunities to share my experience and insights
Having access to professional development programmes Networking for contacts locally and regionally
Opportunities to obtain more directorships Belonging to a professional community
Information about the latest developments in governance thinking Being part of a prestigious organization
Opportunities to be involved in local activities and events Opportunities for personal and family involvement
Being part of an organization that helps shape policy and community thinking on business issues Recognized credentials (post-nominals)
 
(12) I would like to be informed about*  Tick as many as apply.
Events and Activities Board room hire
Director Development Programmes Other Facilities for members
The Annual Conference Special Membership offers
International Meetings and Courses The Board Appointments Service
Local Meetings Board and Director Appraisals
Car hire offers Remuneration Statistics
Card / Finance offers D&O Liability Insurance
Advisory Services Meditation and Arbitration
 
(13) Career (you may email your CV to us if you prefer)
Number of years director experience
Number of years business experience
 
(14) List of positions in last 10 years
Position(1)
Organization Position
Governance/ Management
Business Type
Industry
Start Date  (yyyy-mm-dd) Finish Date  (yyyy-mm-dd)
Asset ($m) Staff No. Turnover ($m)
 
Position(2)
Organization Position
Governance/ Management
Business Type
Industry
Start Date  (yyyy-mm-dd) Finish Date  (yyyy-mm-dd)
Asset ($m) Staff No. Turnover ($m)
 
Position(3)
Organization Position
Governance/ Management
Business Type
Industry
Start Date  (yyyy-mm-dd) Finish Date  (yyyy-mm-dd)
Asset ($m) Staff No. Turnover ($m)
 
Position(4)
Organization Position
Governance/ Management
Business Type
Industry
Start Date  (yyyy-mm-dd) Finish Date  (yyyy-mm-dd)
Asset ($m) Staff No. Turnover ($m)
 
Position(5)
Organization Position
Governance/ Management
Business Type
Industry
Start Date  (yyyy-mm-dd) Finish Date  (yyyy-mm-dd)
Asset ($m) Staff No. Turnover ($m)
 
(15) Applicant Consents  Please refer to Instructions for full text of consents.
a.* I agree to the terms and conditions of the Personal Data Protection and Application Statement.
b.  I agree to have my name and preferred contact details and Branch affiliation available,
to members only, on the Mudara IOD website.
  Please tick at least one Postal Address, Email Address, Phone
c.  I would like to make my Personal Data made available to approved enquirers through
the Mudara IOD's Board Appointment Service.
d.  I would like to participate in the Directors Remuneration Survey.
  (we will send you an invitation to the link on our website after your registration)