I hereby apply for Membership ad eundem of the Faculty of Occupational Medicine and declare that the information provided is complete and accurate.

I understand that applications are subject to:

a non-refundable administrative charge
assessment and, where appropriate, approval by the Specialist Advisory (Sub-) Committee on behalf of the Faculty Board

and that if my application is successful, before admission to Membership of the Faculty, I am required to:

consent to a Form of Faith
pay a Membership Admission fee
pay annual subscriptions
comply with the Faculty’s or other appropriate Continuing Professional Development Scheme

until such time as I tender my resignation from the Faculty in writing.

I understand that the personal data provided on this form will be used in accordance with the Faculty’s registration under the Data Protection Act 1998. It will not be passed to external commercial organisations.

I declare to the best of my knowledge that the information contained on this form is accurate and I am not currently aware of any outstanding disciplinary, professional conduct and/or performance issues against me.

Member via ad eundem application form