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PALS Membership (for 3 members)

It should only take around 10 minutes to complete your PALS membership.
All fields are required.

Gender (Discrete)

This field will be auto populated based on the 'Gender' selection. It should contain at least 1 number but could contain multiple from a 'Team' subscription where multiple members have been added.

Grade (Discrete)

This field will be auto populated based on the 'Grade' dropdown selection. It should contain at least 1 number but could contain multiple from a 'Team' subscription where multiple members have been added.

Retire (Discrete)

This field will be auto populated based on the 'Retire in 5 years' selection. It should contain at least 1 number but could contain multiple from a 'Team' subscription where multiple members have been added.

Member 1 First Name

Last Name

Gender

The e-mail address that NSNF emails should be sent to

Backup Email Address

We will only use this email address if we lose contact with this team member via the main email address provided above.

Personal Phone Number

We will only use this if we lose contact with the team member via both of the email addresses given above.

Home Address Line 1

Home Town or City

Home Postcode

Please tell us your role

Grade

Do you plan to retire in the next five years?

Add a Member

If you would like to add another team member you can do it here.

Member 2 First Name

Last Name

Gender

The e-mail address that NSNF emails should be sent to

Backup Email Address

We will only use this email address if we lose contact with this team member via the main email address provided above.

Personal Phone Number

We will only use this if we lose contact with the team member via both of the email addresses given above.

Home Address Line 1

Home Town or City

Home Postcode

Please tell us your role

Grade

Do you plan to retire in the next five years?

Member 3 First Name

Last Name

Gender

The e-mail address that NSNF emails should be sent to

Backup Email Address

We will only use this email address if we lose contact with this team member via the main email address provided above.

Personal Phone Number

We will only use this if we lose contact with the team member via both of the email addresses given above.

Home Address Line 1

Home Town or City

Home Postcode

Please tell us your role

Grade

Do you plan to retire in the next five years?

Member 4 First Name

Last Name

Gender

The e-mail address that NSNF emails should be sent to

Backup Email Address

We will only use this email address if we lose contact with this team member via the main email address provided above.

Personal Phone Number

We will only use this if we lose contact with the team member via both of the email addresses given above.

Home Address Line 1

Home Town or City

Home Postcode

Please tell us your role

Grade

Do you plan to retire in the next five years?

Member 5 First Name

Last Name

Gender

The e-mail address that NSNF emails should be sent to

Backup Email Address

We will only use this email address if we lose contact with this team member via the main email address provided above.

Personal Phone Number

We will only use this if we lose contact with the team member via both of the email addresses given above.

Home Address Line 1

Home Town or City

Home Postcode

Please tell us your role

Grade

Do you plan to retire in the next five years?

Member 6 First Name

Last Name

Gender

The e-mail address that NSNF emails should be sent to

Backup Email Address

We will only use this email address if we lose contact with this team member via the main email address provided above.

Personal Phone Number

We will only use this if we lose contact with the team member via both of the email addresses given above.

Home Address Line 1

Home Town or City

Home Postcode

Please tell us your role

Grade

Do you plan to retire in the next five years?

Work Organisation

Please tell us the name of your Hospital Trust, Service, or Institution.

Work Postcode

I consent to the above information being entered onto the National Stroke Nursing Forum Database which can be accessed by members of the forum only

I have read and agree with the NSNF membership terms and conditions

I would prefer to receive an invoice before making payment

Invoice Details Reference / PO Number for your Invoice

Contact Name for your Invoice

Contact Email Address for your Invoice

Almost done

Click the button below to submit your membership request and arrange payment through our provider, GoCardless.