• Affiliate membership application form

  • Please read the Affiliate membership eligibility criteria before completing the application form. Complete all sections and submit with a copy of your current full curriculum vitae.

  • Personal details

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    Medical registration 

    You must be currently registered with the GMC or the relevant professional body in the country in which you are practising or where you were awarded your primary medical qualification.

  • Contact details

  • Primiary medical qualification

    Your medical school and qualification must be listed in the WHO Directory.

  • Connection to pharmaceutical medicine

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  • Declaration

    I would like to apply for Affiliate membership of the Faculty of Pharmaceutical Medicine (FPM) as indicated, and declare that the information given on this form is true to the best of my belief and knowledge. I hereby consent to being admitted to membership of FPM and faithfully promise to abide by FPM's Articles of Association and Regulations and the Laws, Bye-Laws, Statutes and Regulations of the Parent Colleges as they apply to members of the Faculty of Pharmaceutical Medicine.

     

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  • Data protection

    The Data Protection Act requires organisations or agencies collecting personal data on individuals to gain their consent before collecting, storing, publishing or analysing their data. By completing and signing this application for membership of FPM you are giving your consent for your data to be stored and used by FPM. All data will be treated with the strictest confidence and will only be used for legitimate FPM purposes, see our Privacy Policy.

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