Home
Membership Application Form
Please print out this page and send completed with your cheque
All hospital locum doctors, unemployed, NCCG and victimised doctors are eligible for membership of this association.
TITLE
 
SURNAME
 
FIRST NAMES
 
ADDRESS FOR CORRESPONDENCE
 
EMAIL ADDRESS
 
TELEPHONE NO
 
FAX NO
 
QUALIFICATIONS
 
SPECIALITIES IF ANY
 
GRADES OF POSTS HELD
HO
 
SHO
 
REG
 
SEN REG
 
CONS
 
ASSOC SP
 
STAFF GRADE
 
OTHER (specify)
 
GMC REG NO
 
FULL / LIMITED
 
PLEASE TICK YOUR SUBSCRIPTION TYPE
  £20 to join and for a year
 
  £25 for overseas subscription
 
  Free for unemployed doctors or those who cannot work for any reason
 
*
 
I HAVE ENCLOSED A CHEQUE FOR THE AMOUNT SPECIFIED ABOVE * UNLESS FREE
 
MADE PAYABLE TO "Locum Doctors Association"
SIGNATURE
 
DATE
 
  Please return to:
Locum Doctors Association, 8 Martine Close, Melling, Merseyside. L31 1DJ.


Home
Who's Who ?
Members
Become a member of the LDA
Current issues
LDA annual report
Documents and LDA comments
Frequently  Asked Questions
Links
Our contact details

BackForward
 
Suggestions box
 
http://www.youservices.com