JotForm

LMC Buying Group Membership Registration

Please complete the form below to sign up for our membership service and/or to register for login details for the website.
Practice Name *

Practice Address:

Street Address
Street Address Line 2
City	County
Postcode	Country

Phone Number: *

- Area Code Phone Number
NHS Practice Code
Your Name *

First Name Last Name
Your Job Role *
Your Email *
March Prize Draw Code
Enter the prize draw code here to be entered into our Easter competition.
Where did you hear about us?

A colleague The LMC/LDC in your area An approved supplier Social Media Google Other option
Membership

The practice's basic information (name, address, telephone number) will be held on a secure database so the Buying Group and their suppliers know which practices are eligible for Buying Group deals. Please tick the box below if you consent to your practice being a Buying Group member.
*

I want our practice to be a member of the LMC Buying Group.
Consent

We need to gain your explicit consent about what we can do with your personal data. Please read the statements below and tick the boxes as appropriate. In order to provide you with login details you need to select box one as a minimum.
*

I consent to my name and email address being kept on the Buying Group's members' database for administrative purposes. If you leave your job, we will delete your details. I consent to my name and email address being used by the Buying Group to send me membership updates (this includes details of new suppliers and the annual flu vaccine deals) by email. I understand that if I tick this box I can still unsubscribe at any time. I consent to my name and email address being used by Buying Group suppliers to send me updates by email. I understand that I understand that if I tick this box I can still unsubscribe at any time.
Privacy Policy
We will only use any information that you provide consistent with the principles of the General Data Protection Regulations. Where we ask for personal information (your contact details) this is to ensure we provide you with information that we believe is important to your membership and to help us and our suppliers identify if your practice is eligible for the deals we have negotiated. At no time will your personal information be shared with third parties unless you have given us permission to do so. Other information collected is to help us to continually improve our service to you. *

I have read, understood, and accepted the PRIVACY POLICY for membership.
Once you submit your application, you will receive a confirmation email from the LMC Buying Group.

Thank you!
Should be Empty:

LMC Buying Group Membership Registration

Membership

Consent

Privacy Policy