BAPEN Medical Trainee Doctors Price: Free First Name:* First Name Required Last Name:* Last Name Required Address Line 1:* Address Line 1 is Required Address Line 2: Address Line 2 is not valid City:* City is Required Country:* Country is Required -- Select Country -- United Kingdom (UK) Afghanistan Åland Islands Albania Algeria Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belau Belize Benin Bermuda Bhutan Bolivia Bonaire, Saint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo (Brazzaville) Congo (Kinshasa) Cook Islands Costa Rica Croatia Cuba CuraÇao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Republic of Ireland Isle of Man Israel Italy Ivory Coast Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao S.A.R., China Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Norway Oman Pakistan Palestinian Territory Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Martin (Dutch part) Saint Pierre and Miquelon Saint Vincent and the Grenadines San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia/Sandwich Islands South Korea South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United States (US) Uruguay Uzbekistan Vanuatu Vatican Venezuela Vietnam Wallis and Futuna Western Sahara Western Samoa Yemen Zambia Zimbabwe County:* County is Required Post Code:* Post Code is Required Phone: Phone is not valid Organisation: Organisation is not valid Same as above address?:* Same as above address? is Required Yes No Address: Address is not valid Town: Town is not valid City: City is not valid County: County is not valid Post Code: Post Code is not valid Preferred Tel. 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No. is not valid Email for correspondence:* Email for correspondence is Required Job title:* Job title is Required Place of work:* Place of work is Required County (for place of work):* County (for place of work) is Required ---------Northern IrelandRepublic of IrelandScotlandWalesBedfordshireBerkshireBristolBuckinghamshireCambridgeshireCheshireCornwallCumberlandDerbyshireDevonDorsetDurhamEssexGloucestershireGreater ManchesterHampshireHerefordshireHertfordshireHuntingdonshireKentLancashireLeicestershireLincolnshireLondonMerseysideMiddlesexNorfolkNorthamptonshireNorthumberlandNottinghamshireOxfordshireRutlandShropshireSomersetStaffordshireSuffolkSurreySussexTyne and WearWarwickshireWest MidlandsWestmorelandWiltshireWorcestershireYorkshireEuropeWorldwide NHS/Healthcare Region:* NHS/Healthcare Region is Required ---------Not ApplicableAbertaw Bro Morgannwg University Health BoardAneurin Bevan Health BoardArden Herefordshire WorcestershireAyrshire & Arran NHSBath Gloucestershire Swindon & WiltshireBelfast HSC TrustBetsi Cadwalader University Health BoardBirmingham & The Black CountryBorders NHSBristol North Somerset Somerset & South GloucestershireCardiff & Vale University Health BoardCheshire Warrington & WirralCumbria Northumberland Tyne & WearCwm Taf Health BoardDerbyshire & NottinghamshireDevon Cornwall & Isles of ScillyDumfries & Galloway NHSDurham Darlington & TeesEast AngliaEssexFife NHSForth Valley NHSGrampian NHSGreater Glasgow & Clyde NHSGreater ManchesterHertfordshire & South MidlandsHighland NHSHywel Dda University Health BoardKent & MedwayLanarkshire NHSLancashireLeicestershire & LincolnshireLondonLothian NHSMerseysideNorth Yorkshire & HumberNorthern HSC TrustOrkney NHSPowys Teaching Health BoardShetland NHSShropshire & StaffordshireSouth Eastern HSC TrustSouth Yorkshire & BassetlawSouthern HSC TrustSurrey & SussexTayside NHSThames ValleyWessexWest YorkshireWestern HSC TrustWestern Isles NHS GMC Number: GMC Number is not valid Professional Group: Professional Group is not valid ---------DietitianPatient/CarerScientistDoctorPharmacistSpeech and Language TherapistNurseStudentOther Professional Speciality/Interests:* Professional Speciality/Interests is Required NoneCare of the ElderlyClinical biochemistryClinical Nutrition ResearchCommunityDiabetesGastroenterologyGeneral PracticeGI SurgeryHepatologyHome Enteral FeedingIntensive CareIntestinal FailureNeurologyObesityOncologyPaediatricsPalliative carePancreatic diseasePN / HPNRenalResearchRespiratoryScience of NutritionStrokeSurgery (non-GI) Please confirm if you are still a trainee:* Please confirm if you are still a trainee is Required Yes No Would you like to complete these optional questions?:* Would you like to complete these optional questions? is Required Yes No Which category best describes your involvement as a BAPEN member?: Which category best describes your involvement as a BAPEN member? is not valid ---------DietitianDoctorIndustry PartnerMedical TraineeNurseNurse Specialist - NutritionPatientPharmacistRetiredAcademics (non-NHS)StudentTrusteeOther (please specify) Other profession: Other profession is not valid Are you a member of the BAPEN Leadership Team?: Are you a member of the BAPEN Leadership Team? is not valid BAPEN Executive BAPEN Council BAPEN Trustee None of the above What is your age?: What is your age? is not valid ---------16-1920-2425-2930-3435-3940-4445-4950-5455-5960-6465-7070+ Do you have a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities?: Do you have a physical or mental impairment which has a substantial and long-term adverse effect on your ability to carry out normal day-to-day activities? is not valid Yes No Prefer not to say If yes, please indicate the nature of your disability: If yes, please indicate the nature of your disability is not valid ---------Mobility/physical coordinationMental HealthVisual ImpairmentDyslexiaHearing ImpairmentPrefer not to sayOther (please specify) Other disability: Other disability is not valid Ethnicity: Ethnicity is not valid Asian Black Mixed White Other Asian: Asian is not valid Bangladeshi Chinese Indian Pakistani Asian Other Black: Black is not valid African Caribbean Black Other Mixed: Mixed is not valid White and Asian White and Black African White and Black Caribbean Mixed Other White: White is not valid British Gypsy, Roma or Irish Traveller Irish White Other White not specified Other: Other is not valid Arab Any other ethnic group How do you prefer to identify yourself?: How do you prefer to identify yourself? 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