Membership Application Form

This form should be completed on the screen, printed and then mailed to the address at the bottom of the form.

All applications for membership must be:

  • signed by 2 Ordinary Members of the Society; and
  • accompanied by a brief CV;

All fields are required unless otherwise marked

Membership type
About you
Your professional details
Your contact details at your place of work
optional
optional
Your home address
optional
How should we contact you?

When sending me mail, please use my:

Publication consent

Opportunities may arise for The Vascular Society to share your contact details (name, hospital, postal and e-mail address) with corporate sponsors or other third parties which we think may be of interest to you. If you have objection to this please indicate in the box and we will amend our records.

We the undersigned, as Ordinary Members of the Vascular Surgical Society of Great Britain and Ireland testify that the above named person is personally known to us and is in every way a suitable candidate for election

 

Signed 1:____________________________________________ Name (capitals):__________________________

 

Signed 2:____________________________________________ Name (capitals):__________________________

 

Date received:________________________ Approved:_________________________________

 

 

 

or Clear all data from the form

Join the Vascular Society