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| Application for Ordinary Membership |
| Surname: |
First Names: |
| First Name Spouse: |
Partners Name: |
| Address for correspondence: |
Telephone Nos: |
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Home: |
Work: |
Rooms |
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Fax Nos: |
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Home: |
Work: |
Rooms: |
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| Post Code: |
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| Signature: |
E Mail: |
Proposer:
(Signature) |
Seconder:
(Signature) |
| The Proposer & Seconder Must be Members of the
BHS. |
| Job Title: (Date appointed) |
Profession: |
Affiliation: (Hospital, University etc.).
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Degrees: (inc. Institution, Date, Degree, Date SR/SpR
Training Commenced).
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Research Interest:
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Papers given at BHS:
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publications (inc. chapters in books etc) relating
to the hip: max 3.
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| Please indicate whether or not you are a member of
the BHS. |
| Member: |
Fellow: |
Associate: |
Non-member: |
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