Signup Form (direct debit payments)

* Membership Type

Full Member (Direct Debit Payments) £55.00 for each year Registered nurse working within urology
Associate Member (Direct Debit Payments) £55.00 for each year Any healthcare professional not eligible for full membership
Corporate Member (Direct Debit Payments) £1,500.00 for each year Company with an interest in urology
Retired Membership Free must provide proof no longer working

Payment System

Direct Debit Payments Pay for BAUN membership by Direct Debit processed by GoCardless

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 Password

must be 6 or more characters

* Confirm Your Password

* Contact Telephone

Mobile

Home Telephone

Date of Birth

Job Title

* Hospital / Organisation

Department

Address Information

* Work Address 1

Work Address 2

* Work City

* Work County/Region/State

* Work Country

* Work Postcode

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

* NMC Number

* NMC Expiry Date

Member of Other Associations

* Mailing Address 1

(your membership card will be sent to this address)

Mailing Address 2

Mailing Address 3

* Mailing City

* Mailing Postcode

* Mailing County/Region/State

* Mailing Country

Alternative Email

Agree to vote by electronic means

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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?

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

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