Signup Form (alternative payments)

* Membership Type

Full Member (All Other Payments) £55.00 for one year Registered nurse working within urology
Associate Member (All Other Payments) £55.00 for one year Any healthcare professional not eligible for full membership
Corporate Member (All Other Payments) £1,500.00 for one year Company with an interest in urology

* Payment System

Pay online by credit card/debit card Accepted cards: Visa/Mastercard/Maestro processed by WorldPay Alternative Payments Pay by cheque / bank transfer / invoice

Title

(Mr, Mrs, Ms, Miss, Dr etc)

* First & Last Name

* Your E-Mail Address

a confirmation email will be sent to you at this address

* Choose a Username

it must be 4 or more characters in length
may only contain letters, numbers, and underscores

* Choose a Password

must be 6 or more characters

* Confirm Your Password

* Contact Telephone

Mobile

Home Telephone

Date of Birth

Job Title

* Hospital / Organisation

Department

Ext Bleep

Fax

Area of Work

Area Speciality

Would you be happy to speak at a BAUN event?

(BAUN are always looking for new speakers for study days and events)

Which areas of your speciality would you be happy to speak on?

Qualifications

Member of Other Associations

* NMC Number

* NMC Expiry Date

* Mailing Address 1

(your membership card will be sent to this address)

Mailing Address 2

Mailing Address 3

* Mailing City

* Mailing County/Region/State

* Mailing Postcode

* Mailing Country

Alternative Email

Agree to vote by electronic means

Yes
No

* Where did you hear about BAUN?

Please Specify / Other

To help with membership and offers, please let us know the member, company, offer, event, or other channel your heard about BAUN from.

Receive Email Information?

Would you like to receive email information from BAUN selected organisations, including promotional information from pharmaceutical companies?

Yes

Receive Postal Information?

Would you like to receive postal information from BAUN selected organisations

Yes

Here is our Privacy Policy

* To become a member we need you to read and understand our privacy policy and accept its terms