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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
Email

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
What is your religion or belief?
Buddhist
Christian
Hindu
Jewish
Muslim
Sikh
Other religion/belief
Ethnicity
Choose one selection from the list below to indicate your cultural background:

a) White:

British
Irish
Any other white background


b) Mixed:

White and Black Caribbean
White and Black African
White and Asian
Any other mixed background


c) Asian or Asian British:

Indian
Pakistani
Bangladeshi
Any other Asian background


d) Black or Black British:

Carribean
African
Any other Black background


e) Chinese or other ethnic group:

Chinese
Any other background
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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