ASSOCIATE MEMBER

Please fill in your details below and once submitted with payment please allow 10 working days for your application to be processed

Surname:*
Maiden Name:
First Name/s:
Title:*
Address For Correspondence:
Date Of Birth:*
Telephone (Home):*
Telephone (Mobile):
E-mail Address:
Name of Training School:
Surname at time of training:*
Year Of Qualification:*
GDC Registration Number:
DATA PROTECTION ACT: If you do not wish your name to be divulged to a third party, please tick here:
I wish to apply for membership of BSDHT and agree to pay the annual subscription fee of £85.00 + £15.00 (overseas postage, if appropriate).: