ONLINE MEMBERSHIP APPLICATION FORM
Full Name
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Address including postcode
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Telephone number (s)
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Date of Birth
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Archdiocese
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Professional Qualifications and employment history .You do not have to state where you work unless you want to only what training and experience you have.
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Are you working full time?
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Yes
No
Are you working part time?
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Yes
No
Are you retired?
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Yes
No
Are you a student nurse?
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Yes
No
Email adress
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Full Membership Subscription £30
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Yes
No
Associate Membership / Student Nurse Membership /Retired Membership Subscription £15
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Yes
No
Payment method -Paypal - (Do this via our Paypal Payments page after completion of this form)
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Yes
No
Payment method -Cheque
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Yes
No
Payment - other method
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Yes
No