BAP Membership Application Form

Title: Title is required.* required

First Name: First Name is required.* required

Last Name: Last Name is required.* required

Date of Birth: A value is required.Invalid format.eg. dd/mm/yyyy

Membership Type: Full Membership (due in March), £80.00 p.a. Training Membership (due in March), £20.00 p.a.

Your Status: Clinical Preclinical Pharmacist Industry OtherTick all that apply

Research Active: Yes No

Present Post: Present Post is required.* required

Work Address: Work Address is required.* required

Telephone: Telephone is required.* required

Email Address: A value is required.Invalid format.* required

PhD Year: if applicable

Qualifications: Including dates and awarding body

Upload Your CV: PDF or Word document preferred

Specific Interests: i.e. psychiatric, psychological, experimental, pharmaceutical

Sponsor: Name, address and email of BAP Full Member willing to sponsor this application

These questions are not directly related to your membership application, however, it will help us to plan ahead and better meet the needs of members if you could spend a few moments to answer them. The data collected will be held in accordance with the requirements of the Data Protection Act 1998.

Sex: Male Female

Do you have a clinical degree? No Yes

If yes, which field? Medicine Nursing Clinical Psychology

Other degree type: Please specify

Which best describes your main job (select one)? Non-clinical academic in substantive post
Non-clinical academic in limited contract post (eg post-doc etc)
Non-clinical academic in training post/student (eg PhD student)
Clinical academic in substantive post
Clinical academic in training post (eg research fellow)
Clinician in substantive post (eg consultant)
Clinician in training post (eg SpR)
Industry - non-clinical post
Industry - clinician/clinically related post

Other job type: Please specify

Reasearch Activity Main ResearchWhich best describes your research activity? (tick as many as apply) - please indicate your main one
  Human - therapeutics (eg drug trials)
Human - experimental (eg aetiology/mechanisms)
Human - theoretical (eg literature, data-base studies)
Human - technical
Pre-clinical - behavioural
Pre-clinical - biochemical/physiological/electrophysiological
Pre-clinical - genetic/genomic
Pre-clinical - technical/in vitro

Other research: Please specify

Please give 2 key words for research/clinical interest (required): First Keyword: First Keyword is required.* required

Second Keyword: Second Keyword is required.* required

Please indicate if you do not want to be included in the BAP Handbook (only items marked with * will be included): Handbook Entry: I do not want to be included in the BAP handbook

Other Societies: I do not wish my details to be given to other scientific societies or associations for the purpose of mailing information about their activities. If I leave this box unchecked I understand that this information may from time to time be passed on to suitable organisations for this purpose only.

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