ACP Registration Page - ACP Membership Form

Contact Details

Title

First Name

Last Name

Position

Institution

Address Line 1

Address Line 2

Address Line 3

City

County/State

Postcode

Country

To ensure you are getting the most out of your membership, please provide us with an email address, which is not an nhs.net domain, as your primary email address. Unfortunately we cannot guarantee that the fortnightly ACP newsletter will be received by those with an nhs.net address.

Primary Email Address

Verify Email Address

Additional Email

Telephone

Consultant

AMOUNT

100.00

TOTAL

0.00

Medical Oncology Specialist Trainee

AMOUNT

50.00

TOTAL

0.00

Non-Career Grade Doctor

AMOUNT

50.00

TOTAL

0.00

Retired

AMOUNT

0.00

TOTAL

0.00

Billing Address

The Contact Address is the same as the Billing Address

The Billing Address is different to the Contact Address

Su	Mo	Tu	We	Th	Fr	Sa
Javascript must be enabled

Su	Mo	Tu	We	Th	Fr	Sa
Javascript must be enabled

Su	Mo	Tu	We	Th	Fr	Sa
Javascript must be enabled

Participation in Surveys

The ACP is sometimes asked to circulate details of national and global surveys to members. All requests are reviewed and approved by a sub-committee of the ACP Executive Committee for their importance and relevance to members. Please indicate if you would be happy to participate in such surveys?

Yes

Membership Directory

The ACP has a Membership Directory which is accessible to members only to view via the ACP website. The directory displays members’ names, hospital, position and sub-specialisation and allows members to contact each other without disclosing direct contact details.

Yes, I wish to be included in the ACP Membership Directory

No, I do not wish to be included in the ACP Membership Directory

Summary

Privacy Policy

If you would like to view the ACP privacy notice please click here.

Terms and Conditions

By completing this online form I agree to become a member of the ACP and I am happy to receive communications from ACP regarding my membership, relevant events, activities and general medical oncology news and information. I understand my data will not be shared with third parties.

Agree

We are using a temporary cookie to streamline your experience. No personal data is stored and the cookie is removed once you complete your registration.

ACP Membership Form

Contact Details

Billing Address

Further Information

Registered Specialities (CCT)

Consultant Region

Year appointed to first consultant post

Year appointed to current consultant post

Sub-Specialisation

Commenced Medical Oncology Training (month and year)

What is your Education Provider Network

Are you an academic clinical trainee?

Expected date of CCT (If not known please include current approximation)

Have you completed or do you intend to complete a higher degree?

Do you have a clear sub-speciality (cancer site) interest(s)

PhD

MD

MSc

Current Grade (Non Career Grade Doctor)

Other (Please specify)

Do you intend to complete training in medical oncology and obtain a CCT to CESR (or portfolio pathway)?

Retirement Date

Last post before retirement

Are you still active in any of the following areas?

Support for ACP Application

Participation in Surveys

Membership Directory

Summary

Privacy Policy

Terms and Conditions

Payment

Thank you

ACP Membership Form

Contact Details

Billing Address

Further Information

Registered Specialities (CCT)

Consultant Region

Year appointed to first consultant post

Year appointed to current consultant post

Sub-Specialisation

Commenced Medical Oncology Training (month and year)

What is your Education Provider Network

Are you an academic clinical trainee?

Expected date of CCT (If not known please include current approximation)

Have you completed or do you intend to complete a higher degree?

Do you have a clear sub-speciality (cancer site) interest(s)

PhD

MD

MSc

Current Grade (Non Career Grade Doctor)

Other (Please specify)

Do you intend to complete training in medical oncology and obtain a CCT to CESR (or portfolio pathway)?

Retirement Date

Last post before retirement

Are you still active in any of the following areas?

Support for ACP Application

Participation in Surveys

Membership Directory

Summary

Privacy Policy

Terms and Conditions

Payment

Thank you

Your Browser Settings have Cookies Disabled