Guidelines for completing the CPD Registration Form

To enable a quick and accurate entry of your registration details please keep the following general points in mind:

1. Use a ballpoint pen with black or dark blue ink to complete the form.
2. Write in allocated areas on the form and ensure numbers/letters avoid contact with box edges.
3. Print your responses firmly and neatly using CAPITALS for all entries other than your email address.
4. Leave a box clear to indicate a space when entering information into text boxes.

Please refer to each of the following points as you complete the corresponding section of the form:

1. Indicate all current College subscriptions(s), and one lead College from the three administering CPD.
2. Enter your GMC number, date of birth in the form dd/mm/yyyy.
   Enter your full name
   Indicate sex
3. Registration Fee – please tick appropriate box or enclose cheque for £120 made payable to The Royal College of Physicians. Alternatively, to apply for Membership, contact the Membership department of your Lead College:
    

   • Royal College of Physicians of Edinburgh
     9 Queen Street, Edinburgh EH2 1JQ
     Membership Tel: 0131 247 3637 Email: membership@rcpe.ac.uk

   • Royal College of Physicians and Surgeons of Glasgow
     232 St Vincent Street, Glasgow, G2 5RJ
     Membership Tel: 0141 221 6072 Email: subs@rcpsg.ac.uk

   • Royal College of Physicians of London
     11 St Andrews Place, Regent’s Park, London NW1 4LE
     Membership Tel: 020 7935 1174 Ext 362 Email: membership@rcplondon.ac.uk

4. Enter your full home address, using separate lines as appropriate for a mailing address, and include the country only if outside the UK.
5. Indicate your work details as appropriate.
   Enter your full main work address, in the same format as for your home address.
6. Indicate your main and any additional specialties using the following codes:
   • 89 allergy
   • 01 Audiological Medicine
   • 85 cardiology
   • 05 dermatology
   • 18 Endocrinology & Diabetes Mellitus
   • 19 gastroenterology & hepatology
   • 07 general internal medicine
   • 20 genetics
   • 08 genito-urinary medicine
   • 06 geriatrics
   • 30 haematology
   • 88 immunology
   • 09 Infectious Diseases
   • 09 communicable diseases
   • 29 intensive care
   • 27 Metabolic Medicine
   • 11 neurology
   • 12 nuclear medicine
   • 24 oncology
   • 36 Ophthalmology
   • 16 palliative medicine
   • 22 pharmacology
   • 41 rehabilitation medicine
   • 47 renal disease
   • 48 respiratory medicine
   • 49 rheumatology
   • 100 Stroke Medicine
   • 31 Tropical Disease
7. Registration start date is always 1st April each year and the appropriate date has been pre-entered on your form.

Please sign and date your acceptance of the Data Protection statement.

Please check your form, make and retain a personal copy, and return the original to the Office at the College you have chosen to administer your CPD.

Please note we will not accept faxed or emailed forms