Record for

Member Number:

Firstname:

Lastname:

Full Salutation:


Please include your title (Dr, Professor, Mr, Ms, Sir) and your last name

Date of Birth:

 dd/mm/yyyy

Gender:

GMC Number:

Specialty:

Interest:
Involved in Acute Medical Take:
(UK Doctors only)		 Check the box if you are involved in Acute Medical Take.

Position:

Date of first
Consultant appointment:

 dd/mm/yyyy

Home Address

Address Name for College Mailings:

Address Line 1:

Address Line 2:

Address Line 3:

Town/City:

County/Area:

UK Postcode:

Country:

Professional Address

Address Line 1:

Address Line 2:

Address Line 3:

Town/City:

County/Area:

UK Postcode:

Country:

Phone/Fax/e-mail page

EMail 1

EMail 2

Work Phone 1

Home Phone 1

Mobile

Work Fax 1

Other

Please include full telephone dialling codes.

Memberships and Fellowships of other Medical Colleges or their Faculties

Current Memberships:

Update your Memberships:
Please include year of admission eg: FRACP 1999

Qualifications

Current Qualifications:

Please update your record:
Please include University and Year e.g: PhD Cairo 2003

College E-Mails

Fellows, Collegiate Members and Associates are entitled to receive regular e-mails and updates from the College.

Please indicate below if you wish to receive regular e-mails from the College.

 

If you have any queries concerning your records please contact Andrew Napier.