Annual Membership Registration Update 2022
* IMPORTANT TO READ FIRST *
We take protection of your privacy very seriously and recognise the duty of care to the people whose data we hold.

The collected data from this form will be used:
1. Name and Email - to subscribe you to the JOGS mailing list (required mode of communication)
2. Role and Hospital/ School of Medicine - to provide up-to-date basic membership census  
3. Irish Medical Council Registration Number - to confirm proof of medical registration in Ireland
4. Phone Number - to subscribe you to the JOGS WhatsApp Group (optional mode of communication)

If you choose to join the JOGS WhatsApp Group by providing your phone number to receive one-way communication i.e. no other members except the group administrator can text on the group, you should be aware and consent to others in the group viewing your phone number and WhatsApp profile.

We will never share your personal information with anyone without your permission.

You have a choice to unsubscribe from the mailing list and the WhatsApp Group anytime by emailing jogsmembers@gmail.com

* SUBMISSION OF THE FORM SIGNIFIED THAT YOU HAVE READ AND AGREE TO ALL THE STATED TERMS *
Sign in to Google to save your progress. Learn more
Email *
First Name *
Surname *
Role *
*NCHDs only* Irish Medical Council Registration Number (Proof of practice in Ireland) - Write N/A if a Medical Student *
*NCHDs only* Which hospital are you working at? - Write N/A if a Medical Student *
*Medical Student only* Which School of Medicine are you attending? - Write N/A if a NCHD *
Phone number for JOGS WhatsApp group - Write N/A if you do not consent to this *
A copy of your responses will be emailed to the address you provided.
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy