ASPiH Accreditation registration form
Completion of this form confirms an individual or organisation’s intention to submit an application to be considered for an ASPiH accreditation award.

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Email address *
Are you completing this form as an individual, on behalf of an NHS trust simulation centre or an HEI facility? *
Name of employing organisation *
Postcode of employing organisation
Job Title/ Role *
Your role within your organisation
What is your current ASPiH membership status? *
Which accreditation award are you intending to apply for? *
Please give an estimate of the timescale for submission of your completed accreditation application *
How do you anticipate submitting your evidence? *
Please provide details of the shared drive you will use and how access wil be provided to the ASPiH accreditation committee.
Name of contact *
Name of the person to whom future correspondence should be addressed
Email *
Phone number
Please provide any other information below that may be relevant to your accreditation registration
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