UK Endocrine Pathology
Society
Membership Application
Form Download
PDF
Any member of
the Society will be happy to discuss the activities with potential
new members. To apply
for membership, please complete and return this form to the
Secretary, Dr Sarah J Johnson, Consultant Pathologist, Dept of
Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne,
NE1 4LP. There is a
joining fee of £50.
Queries can be made to the Secretary at Sarah.Johnson8@nuth.nhs.uk
Your personal details
Name:
………………………………………………………………………………………………
Degrees and Professional
qualifications:
..…………………………………………………
Current post held:
…………….…………………………………………….……………………
Institution and contact
address:…………………………….…………………………………
………………………………………………………………………….……………………………
Previous relevant positions held with
dates: ………………………………………………
Tel: ………………………………………………………………….………………………………
Fax: …………………………………………………………………………………………………
Email: ………………………………………………………………………………………………
The Data Protection legislation
requires that you indicate your agreement to the publication
of your contact details. Most communication between
members is by group email although some is by
post. The
Society mailing list, including full postal and email
addresses, is available to members through the
password-protected area of the website but is not actively
passed on to any external organisation or
individual.
Brief summary of your endocrine histopathology interests and
current involvement
Statement of
intent
I would like to
join the UK Endocrine
Pathology Society.
I have checked
the requirements of the Society’s Constitution and I agree to
follow these during my membership. I enclose a cheque for £50
(payable to the UK Endocrine
Pathology Society).
In
applying to join the UKEPS Iconfirm that I agree
to inclusion of my name and my contact details (full work postal
address and email address) in the password-protected member-only
part of the UKEPS website. I also agree to email
communication from UKEPS.
Name ……………………………………..
signed …………………………….
date………
Sponsorship
Proposer: ………………………………….
signed ……………………………
date……….
This must
be a current member of the UKEPS.
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