Membership Questionnaire

In order for the BAP to plan ahead and to meet the needs of its members we need to have a better idea of who you are and what you do. We hope the following questionnaire (which will also be completed by new members) will enable us to have a better picture of the Association without being intrusive. It will literally only take a minute to complete so please fill it in now.

The data will be held in accordance with the requirements of the Data Protection Act 1998. Thank you for your help.

Personal Details

Title is required.* required

First Name is required.* required

Last Name is required.* required

Male Female

Professional Details

Current Positio is required.* required

Work Address is required.* required

Telephone is required.* required

Fax is required.* required

Email Address is required.A valid email address is required.* required

No Yes

Medicine Nursing Clinical Psychology

Please specify

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

Please specify

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

Please specify

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

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): I do not want to be included in the BAP handbook (check box)

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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