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Membership-Form
Craig Hughes
2024-08-23T11:47:37+01:00
Membership Application
To join the Association of Anaesthesia Associates
Name
*
First Name
Last Name
Home Address
*
Street Address
Street Address Line 2
City
County
Post Code
Mobile Number
*
Email
*
example@example.com
Work Address
*
Hospital Name
Street Address Line 2
City
County
Post Code
Work Number
Are you currently on the RCoA Managed Voluntary Register?
*
Yes
No
Memberships
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Annual Subscription
Annual membership for Anaesthesia Associates
£
60.00
for each
year
6 Monthly Subscription
6 Monthly membership for Anaesthesia Associates collected twice a year
£
30.00
for each
six months
Trainee Subscription
Annual membership for Trainee Anaesthesia Associates
£
30.00
for each
year
Maternity Leave
Annual membership for Anaesthesia Associates on Maternity Leave
£
30.00
for each
year
Non AA Member
Annual membership for Non Anaesthesia Associates Members
£
60.00
for each
year
Payment Details
First Name
Last Name
Credit Card Number
Security Code
Card Expiration
Do you consent to the Association using your contact details in order to share important developments around the profession and event information? (We will never share your details with a 3rd party without explicit consent)
*
Yes
Please verify that you are human
*
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