UK Endocrine Pathology Society

Membership Application Form  Download PDF

Any member of the society will be happy to discuss the activities with potential new members. To apply for membership, please complete and return this form to the Secretary, Dr Sarah J Johnson, Consultant Pathologist, Dept of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP. There is a joining fee of £50. Queries can be made to the Secretary at Sarah.Johnson8@nuth.nhs.uk 

Your personal details

Name:

Degrees and Professional qualifications:

Current post held:

Institution and contact address:

Previous relevant positions held with dates:

Tel:

Fax:

Email:

The Data Protection legislation requires that you indicate your agreement to the publication of your contact details.  Most communication between members is by group email although some is by post.  The Society mailing list, including full postal and email addresses, is available to members through the password-protected area of the website but is not actively passed on to any external organisation or individual. 

Brief summary of your endocrine histopathology interests and current involvement

Statement of intent

I would like to join the UK Endocrine Pathology Society.  I have checked the requirements of the Society’s Constitution and I agree to follow these during my membership. I enclose a cheque for £50 (payable to the UK Endocrine Pathology Society).

In applying to join the UKEPS Iconfirm that I agree to inclusion of my name and my contact details (full work postal address and email address) in the password-protected member-only part of the UKEPS website.  I also agree to email communication from UKEPS.

Name:

Signed:

Date:

Sponsorship

Proposer:                                                      Signed:

Date:

This must be a current member of the UKEPS