Full Member Application Form

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):
Email Address:
Name of Training School:*
Surname at time of training:
Year of Qualification:*
GDC Registration Number:
Other, please indicate:
DATA PROTECTION ACT: If you do not wish your name to be divulged to a third party, please tick here:
Have you previously been a member of BSDHT?:
If yes, please indicate your membership number or when it was:
I wish to apply for full membership of BSDHT and agree to pay the annual subscription fee of £90.00:
Current Membership No (if renewing):

Enter not this field:

*Indicates a field you must enter.

When you have completed the form, please click the Send Details button ONCE to send