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Affiliates' Registration

Registration form

Please note that we are unable to register anyone outside the UK as an Affiliate.
Email affiliates@rcseng.ac.uk if you are already an affiliate but do not have an Athens username and password.

Highlighted fields

are mandatory.

Personal details

Title

First name(s)

Last name

Please do not use a hospital email address.
Check your email - we will use it to confirm your registration.

Home address in UK

Please give an address that you will use for the duration of your training.

Postcode

Date of Birth

Affiliate number (if known)

Current Level

NB: you must be a UK student or trainee (without MRCS or MJDF/MFDS).

Expected year of graduation

GMC/GDC number if applicable (F1 upwards)

Professional details

Please indicate your top 5 preference specialties

Cardiothoracic

General Surgery

Neurosurgery

Orthopaedic

Otolaryngology

Paediatric

Plastic

Urology

Oral and maxillofacial

Oral and maxillofacial pathology

Oral and microbiology

Public dental health

Orthodontics

Peridontics

Restorative dentistry

Paediatric dentistry

Prosthodontics

Special care dentistry

Don't know

Other - please specify

Equal opportunities

In line with UK legislation and good practice guidelines, we are asking everyone to complete this section. You are not obliged to provide any of the information in this section, but if you do so, it will enable us to monitor our business processes and ensure that we provide equality of opportunity to all.

Nationality

First Language

Gender

Male
Female

Do you have a disability
under the terms of the Disability Discrimination Act 1995 (a person with a physical or mental impairment that affects you ability to carry out normal day to day activities which are substantial, adverse and long term)?

Yes
No

What is your sexual orientation?

Bisexual
Heterosexual
Lesbian or Gay

This information will be held in accordance with the Data Protection Act 1998. It will be available to all College departments and may be shared with any relevant Specialist Associations located within the building. Please notify us of any change to your details.

We would like to keep you informed of other events and activities that may be of interest to you, please tick this box if you do not wish to receive these mailings.

If you wish to pay by cheque you need to print this form off and post to the College marked for the attention of the Affiliates Team. Cheques should be made payable to ‘The Royal College of Surgeons of England’.

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Affiliates' Registration