British Society for Haematology Membership Application Form

Your application - Important information - PLEASE READ

You are required to print your application form, sign it and return it to the BSH office at the following address:

The British Society for Haematology, Membership application, 100 White Lion Street, London, N1 9PF.

If you do not have a printer connected, choose the 'Save my application' option to print this out at a later date.

Your online application will not be processed unless the BSH receive a signed hard copy of your application.

NO handwritten Applications will be accepted

Personal Information
Title*
Initials*
Forename*
Surname*
Date of birth*

Gender*	Male Female
Address Information
Preferred address for contact / mailings*	Home address Professional Address
Organisation
Department
Professional Address*
Town*
County/State
Postcode*
Country*
Work Tel No.*
Home Address*
Town*
County
Postcode*
Country*
Tel No.*
Email address*
Mobile No.
Additional Information
Type of Membership Requested*
Ordinary Associate BMS Nurse membership Trainee Pharmacist membership Developing World If you are applying for Trainee membership you must be in training. Please fill in and post us this additional form to confirm this.

Qualifications*

Present job title, grade, NHS Trust and date of appointment

Previous Haematology posts held with dates*


Haematology sub-speciality/special interests (tick as many as apply)*
Molecular Haematology	Stem cells Transplantation
Laboratory Haematology	Red Cell Disorder/Haemoglobinopathy
Obstetric Haematology	Transfusion Medicine
General Haematology	Haemostasis/Thrombosis
Haemato-oncology

Position (tick as many as apply)*
Consultant	BMS
Specialist Registrar	Nurse
Clinical Scientist	Other Medical
Academic	Other

Interest in Forums*
Science Forum	Paediatric Haematology Forum
BCSH (British Committee for Standards in Haematology)	Nurse Forum

The BSH is planning to compile an online database of members (which will be available to other members only) containing the name, work address, phone number and speciality of each member. If you do not consent to being added to this database please tick this box.
Key Facts Membership Cancellation Rights European Economic Area If you live within the European Economic Area (the European Union, Iceland, Lichtenstein and Norway), you have the following cancellation rights: New Members You may cancel your membership within 7 working days of receiving notification from the British Society for Haematology of the acceptance of your application for membership. Renewals You may cancel your membership within 7 days of receipt by the British Society for Haematology of your renewal payment. We will refund to your credit card/bank, within 30 working days of receiving a cancellation request, the sums actually received from you in relation to membership fees. Rest of World The cancellation rights set out above do not apply to members living outside of the European Economic Area. Membership cancellation requests arising from these areas will be dealt with by the Society on a case by case basis. Subscription and Services New applicants, who must be engaged in the practice or study of Haematology, are required to pay the Full Membership annual subscription, which is currently £140 and includes the British Journey of Haematology and full access to the Society's websites. Members still in the training qualify for a subsidised annual membership subscription of £70 a year (including the Journal) for the duration of their training as long as they have filled in and sent us the relevant form. In addition, there is Associate Membership, available with an annual subscription currently at £70 which includes all mailings (except the British Journal of Haematology) and access to Society's websites but not to the BJH online. Further annual rates available are £30 for Biomedical Scientists and Nurse Practitioners, and £20 for Senior members (for retired practitioners). All applications for membership have to be approved by the Society's Committee which meets four times a year in January, March, June and October. Membership applications, along with any issues you may have in respect of your membership, should be made to Daphne Harvey, Administrator, British Society for Haematology, 100 White Lion Street, London N1 9PF or by email to: daphne.harvey@b-s-h.org.uk
*This form contains important information about your statutory cancellation rights. Please confirm that you have read these and will keep a copy by ticking this box
Due to increased spamming on the web, an additional security question is required to be answered before your membership application form is submitted. Please note that this field is mandatory.

BRITISH SOCIETY FOR HAEMATOLOGY

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