Melanoma Focus Professional Membership Application

Professional Membership Application

Your name

Your email address*

Your phone number

Job Title*

Name of Hospital

Name of Trust

Place of Work or Hospital & Trust if not listed above

Work Address Line 1

Work Address Line 2

Work Address Line 3

Work Town

Work Postcode

Region*

Name of Referee (for anyone other than a consultant member)

Professional Membership includes the following benefits:

Membership of the UK’s principal professional melanoma network
Reduced fees to attend the charity’s annual Focus on Melanoma and Regional meetings
Access to members-only resources
Consultation on significant professional issues being discussed by Melanoma Focus with NICE, Parliamentary groups, the Government and other organisations
All applications other than a consultant membership requires the support of a referee. On completion of your application, please ask your referee to email: memberships@melanomafocus.org

Medical Consultant

Other Clinician/AHP

Nurse/Medical Student

Are you happy for us to keep in touch via email regarding news about the charity, such as our quarterly newsletters?

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