Free Membership Trial - until 28 February 2019

PLEASE COMPLETE IN BLOCK LETTERS

NHSJD

Please complete this form and return it by; Email: membership@rsm.ac.uk or by Post: RTKA-KLLR-YGYG, FREEPOST,
Membership Department, The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE

Name (Title, First name, Surname) Telephone

1. Personal Details

Address Gender Male Female Email

GMC Number (if registered):

Country

Date of Birth Postcode

Please tell us what areas of medicine you are interested in. You can amend/update these at any time.
2. Your main areas of interest

Anaesthesia History of Medicine Pain Medicine

Cardiology Hypnosis & Psychosomatic Medicine Palliative Care
Cardiothoracic Intellectual Disability Pathology
Clinical Forensic & Legal Medicine Innovations in Medicine Patient Safety
Clinical Immunology & Allergy Laryngology & Rhinology Plastic Surgery
Clinical Neurosciences Maternity & the Newborn Psychiatry
Coloproctology Medical Genetics Radiology
Comparative Medicine Military Medicine Respiratory Medicine
Critical Care Medicine Nephrology Rheumatology & Rehabilitation
Dermatology Obstetrics & Gynaecology Sexuality & Sexual Health
Digital Health Occupational Medicine Sleep Medicine
Emergency Medicine Odontology Sport & Exercise Medicine
Endocrinology & Diabetes Oncology Students
Epidemiology & Public Health Open Surgery
Food & Health Ophthalmology Trainees
Gastroenterology & Hepatology Oral & Maxillofacial Surgery Urology
General Practice with Primary Healthcare Orthopaedics Vascular Medicine & Lipids
Geriatrics & Gerontology Otology Venous
Global Health Paediatrics & Child Health
3. Keeping in touch

In order to give you the best possible service, we would like to send you information on events based on your specialty group selection; news
about the members’ club and exclusive member offers which we believe may be of interest to you.
Please tell us the methods of communication you are happy to be contacted by. You can change your preferences at any time.

It is recommended that you select both Email and Post at the minimum, however the RSM’s preferred and most used method of
communication is email.
Email (recommended) Post (recommended) Telephone SMS

The RSM would also like to send you special offers from our specially selected Affinity partners. These could include special offers on Home/
Travel insurance offers, holidays and car purchases. We will always treat your personal details with the utmost care and will never sell, lease or
share them to other companies for marketing purposes. You can change your preferences at anytime.

Yes please, I’d like to hear about special offers by email post (please tick all that apply)
No thanks, I would prefer not to hear about special offers from affinity partners

Terms and conditions

Not available to existing RSM members or those who have been an RSM member within last 12 months. You may attend RSM meetings at member rates providing that
the meeting is within the trial period. You may stay at Domus Medica but your stay must be within your trial period.

Complete this form in BLOCK LETTERS and return it by:

Email: membership@rsm.ac.uk
Post: RTKA-KLLR-YGYJ, FREEPOST, Membership Department,
The Royal Society of Medicine, 1 Wimpole Street, London W1G 0AE