Site last updated on 04/01/2016

First Name

Middle Names (optional)

Surname/ Family Name

Title

Email (required)

Professional Description

Present Appointment

Principal Place of Work

Work Address

Telephone Number (work)

Country of Residence

Membership Type

Supervisor's Letter of Support (if applying for student membership)

Please attach a letter from  your supervisor confirming that you are a full-time student enrolled in a degree/diploma course, and confirming that he/she supports your application.



Do you have an SSBP Sponsor? (A current member of the society willing to support your application)

If yes, your Sponsor's name is:

If you do not have a sponsor, please attach a letter of support from a Senior Colleague (if you are a student, this can be from your Supervisor)

Please attach a short CV

Main areas of clinical and research interest:

I understand that if this application is successful, this information may be stored on a computer and will be covered by the Data Protection Act. (required)


About your work


Membership application details

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Contact Information

If you would like to apply to join the SSBP, please complete our application form below.

 


SSBP Membership Application Form