SRS Membership Application Form
Email address *
Name *
Your answer
Qualifications i.e MBChb, MRCS, MRCP, FRCR, FRCS *
Your answer
Position *
Work Address *
Your answer
Name of Sponsoring SRS Member *
Your answer
I acknowledge that the above SRS member has given authorisation as the sponsor of my membership application *
Required
I acknowledge that the first year membership fee has been paid to Scottish Radiological Society. *
Required
You are paying the annual subscription of £25/year by standing order ( Please add your reference to the standing order as follows, name followed by GMC number) e.g. Roland Rat would be RR2377192 *
Date standing order initiated *
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I agree to the Scottish Radiological Society keeping my contact details for the purpose of membership reasons only and that it is never shared with a third party without my explicit consent *
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