Membership Questionnaire

Title: Title is required.* required

First Name: First Name is required.* required

Last Name: Last Name is required.* required

Year of Birth:

Sex: Male Female

Current Position: Current Positio is required.* required

Work Address: Work Address is required.* required

Telephone: Telephone is required.* required

Fax: Fax is required.* required

Email: Email address is required.* required

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

Which best describes your research activity (tick as many as apply) - please indicate your main one Reasearch Activity Main Research 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
Not currently research active

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 (check box)

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.