Concessionary Monthly

Terms:

£8.34 / Month

First Name: First Name Required

Last Name: Last Name Required

Address Line 1:* Address Line 1 is Required

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City:* City is Required

Country:* Country is Required

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Zip/Postal Code:* Zip/Postal Code is Required

Prefix:* Prefix is Required

What is your preferred name?:* What is your preferred name? is Required

What's your date of birth?: What's your date of birth? is not valid

What qualifications or honour do you have?:* What qualifications or honour do you have? is Required

Please State the Healthcare Profession Governing Body / Regulating Body that you are a Member of (Acronym preferred) and Your Registration Number.:* Please State the Healthcare Profession Governing Body / Regulating Body that you are a Member of (Acronym preferred) and Your Registration Number. is Required

What is your home contact number?: What is your home contact number? is not valid

What is your work contact number?: What is your work contact number? is not valid

What is your mobile contact number?:* What is your mobile contact number? is Required

What is your primary current role?:* What is your primary current role? is Required

Where did you hear about BASEM?:* Where did you hear about BASEM? is Required

What is your primary specific SEM Interest?:* What is your primary specific SEM Interest? is Required

What is the primary organisation you work for?:* What is the primary organisation you work for? is Required

What is your reason for joining BASEM?:* What is your reason for joining BASEM? is Required

What concessionary grade are you applying for?:* What concessionary grade are you applying for? is Required

Which university do you attend?: Which university do you attend? is not valid

Would you prefer to hear from BASEM via post, email or both?:* Would you prefer to hear from BASEM via post, email or both? is Required

I am happy to receive emails regarding BASEM Conferences & Courses: I am happy to receive emails regarding BASEM Conferences & Courses is not valid

I am happy to receive emails regarding External Conferences & Courses: I am happy to receive emails regarding External Conferences & Courses is not valid

I am happy to receive emails regarding Job Vacancies: I am happy to receive emails regarding Job Vacancies is not valid

I am happy to receive emails regarding Awards, Scholarships & Bursaries: I am happy to receive emails regarding Awards, Scholarships & Bursaries is not valid

I am happy to receive emails regarding Requests for Shadowing & Support from Fellow Members: I am happy to receive emails regarding Requests for Shadowing & Support from Fellow Members is not valid

I am happy to receive emails regarding Requests for Referral from Members of the Public: I am happy to receive emails regarding Requests for Referral from Members of the Public is not valid

We offer you the facility to pay your membership fee by monthly instalments. We do not charge any interest or charges. As these terms have been agreed after 18 March 2015 this instalment agreement is not a regulated credit agreement:* We offer you the facility to pay your membership fee by monthly instalments. We do not charge any interest or charges. As these terms have been agreed after 18 March 2015 this instalment agreement is not a regulated credit agreement is Required

I acknowledge the above statement

Are your interests and work mostly related to Physical Activity, Team Sport or MSK?:* Are your interests and work mostly related to Physical Activity, Team Sport or MSK? is Required

Your Area of Expertise is...: Your Area of Expertise is... is not valid

What other organisations are you a member of? (Please use acronyms and commas to separate): What other organisations are you a member of? (Please use acronyms and commas to separate) is not valid

I understand that by signing up to BASEM, my membership will automatically transfer to the College of Sport, Exercise and Musculoskeletal Medicine (CSEM) when it is formally established. I understand that this may affect my membership category and/or price*

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Terms: £8.34 / Month

Description	Amount
Concessionary Monthly – Initial Payment	£8.34
Total	£8.34

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