Associate

If you have a discount code, enter it here

Membership *

Associate - Pro-rata: Nov to Dec - £ 17.33

Total Amount

Account

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

Check Availability
Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Password

Confirm Password

Provide a password for the new account in both fields.

Personal Details

Individual Prefix *

First Name *

Last Name *

Street Address (Primary) *

Supplemental Address 1

Supplemental Address 2

City *

Post Code *

County

Country *

Email address must be an individual account which you have sole access to.

Email (Primary individual account) *

Phone *

Membership information

Profession *

My Affiliations are (OH-related bodies):

I am registered with: *

If 'Other' is selected, please state here:

Other

SOM Regional Group (please select which group you'd like to join) *

How did you hear about us? (e.g. name of webinar or conference)

What is your reason for joining?

If you were recommended by another SOM member please enter their full name here:

Birth Date (This and the optional information below helps SOM to ensure that its services meet the needs of all members)

The optional information below will help SOM to ensure that its services meet the needs of all members.

Gender

Other gender (please specify)

Sexuality

Other sexual orientation (please specify)

Ethnicity

Other ethnic group (please specify)

I declare that the above information is true. I am in good standing with my professional regulators or relevant governing body and I am not subject to supervision and/or restrictions on my practice, nor the subject of any proceedings pending against me. I understand that being a member of the SOM does not confer entitlement to any post-nominal qualifications or use of the SOM logo. I understand that membership may be withdrawn if I act contrary to the charitable objectives of the SOM.

I declare that I am in good standing and not subject to restrictions on my practice. I understand that membership may be withdrawn if I act contrary to the charitable objectives of the SOM. *

Confirm

I agree that my personal data will be used so that the SOM can contact me regarding member benefits such as e news, renewals, regional and national events and job alerts and give my permission for my information to be passed to Oxford University Press so that I can receive the Occupational Medicine Journal, and to James Hallam so that I can be contacted about Nurse Indemnity Cover, if applicable. You are free to update preferences within the member area.

Communications Opt-In Declaration *

Confirm

Header Right

Member Menu

Search form

Associate

Register for our free OH Nurse Bulletin

Register for our free OH GP Bulletin

Register for our free
OH Nurse Bulletin

Register for our free
OH GP Bulletin