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British Intrapartum Care Society
Membership Application and Update Form
* Indicates required question
Are you a new member or updating your details?
*
I am a new member
I am already a member and pay by annual standing order and I am updating my details
I have been a member before and I am re-joining and will pay using the website link
Title
*
Dr
Mr
Miss
Mrs
Ms
Other:
First Name
*
Your answer
Last Name / Surname
*
Your answer
Email
*
Your answer
Address
*
Your answer
Phone number
Your answer
Job Title
*
Your answer
Hospital / Trust / Workplace
*
Your answer
Areas of Particular Interest
Your answer
Annual Fee - choose role
*
Consultant - £50
Trainee / Student - £35
Midwife - £35
Non-clinical member - £35
I confirm that I have set up an annual payment to BICS
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Yes - I am paying by stripe
Yes - I already have a standing order set up
Required
Please confirm the following:
*
I agree that the information provided on this form can be used by the British Intrapartum Care Society (BICS) and others working with them. I understand my right to see the information held about me by BICS.
I agree that I will adhere to the Data Protection Act and I will not disclose any patient identifiable information to the other members of BICS in person, in print, or via electronic media
Required
Signature
*
Your answer
Date
*
MM
/
DD
/
YYYY
Submit
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