ACI Northern Ireland Membership Application Form

All fields marked with an asterisk must be completed.

1. Personal details

Title *
First name *
Surname *
Company position (Director, Chairman, etc) *
Company name *

2. Contact information

(Please omit if this is a private residential address)

Address line 1
Address line 2
Address line 3
Telephone *
Email address *

3. Details of other positions held

Company Name

Audit committee member or chairman

Executive director

Non-executive director

Chief executive officer

Chief financial officer

Head of Internal Audit

Company secretary



4. Do you have concerns with respect to audit committee issues? Please list