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BINA Registration Form
British Indian Nurses Association (BINA)
Thank you for registering to BINA organisation. Please fill below details
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* Indicates required question
Email
*
Your email
Name
*
Your answer
Phone Number
*
Your answer
Gender
*
Female
Male
Date of Birth (DD/MM/YYYY)
*
Your answer
NMC Number
Your answer
Name of Workplace
*
Your answer
UK Workplace Region
Choose
Scotland
Northern Irelans
Wales
North East
North West
Yorkshire and Humber
West Midlands
East Midlands
South West
South East
East of England
Greater London
Other
Area of Work
*
Choose
Hospital Setting
Community Setting
Mental Health Setting
Care Home (Public) Setting
Care Home (Private) Setting
Research Setting
Executive Management
Management
NHS E& I
Teaching setting
Royal College of Nursing Setting
Other
If the answer is other, Please Explain
Your answer
Country of Origin
*
Choose
India
Other
If Answer is other, Please Explain
Your answer
Country of Nursing Training
*
Choose
India
United Kingdom
Other
If Answer is other, Please Explain
Your answer
Are you practicing as Registered Nurse?
*
Yes
No
Name of Nursing Training College and passing year
Your answer
Current role/Specialty
*
Your answer
Current Band
*
Your answer
Share your Ambition, Aspiration and Plans
Your answer
To comply with GDPR, We must tell you that we hold your data to help us to keep you updated with all relevant BINA activities. Are you happy for us to contact you by email or phone?
*
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A copy of your responses will be emailed to the address you provided.
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