Membership Application

Personal Information

Position Held

(Please tick ONE box only)

Medical

NHS Consultant
Senior Lecturer/Professor
Lecturer
* Speciality Registrar
Associate Specialist
General Practitioner
Speciality Doctor
Clinical Assistant/Hospital Practitioner
Retired
Other

Clinical/Non-Medical

Nurse Consultant
Nurse band 7 or above
Nurse band 6 or below
Health Adviser
Other

Non-Clinical

Scientist
Other

Speciality

GU Medicine
Reproductive/Sexual Health
Gynaecology
ID
Microbiology/Virology
Other

Region of Main Employment

Membership Category

First year (to 31/07/2018) price: £-.--
Regular price: £-.--

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