Applying to
join the Gay and Lesbian Association of Doctors and Dentists
This
is the first of two forms you will need to complete to join GLADD.
After this one, you will be directed to a standing order mandate
which we ask you to print out, sign and
return to us.
This is the
form to join GLADD as a medical
or dental student.
If you wish
to join as a qualified member, click here.
Please complete the form carefully. In order to ensure
you have not left out any important information, please use the [TAB]
key to move between
each part of the form. All
fields marked with a * are required. All
the information you provide is treated in the strictest confidence, and
never released to a third party without your permission.
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| Part 1 - about you |
| Title* |
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| Gender* |
Male
Female |
| First name* |
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| Surname* |
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| Address* |
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| Postcode* |
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| Phone* |
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| Email* |
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| How
did you discover GLADD?* |
Personal recommendation |
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Journal / magazine (please tell us which one):
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Internet / web search |
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By another means:
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| Part 2
- about your studies |
| What
are you studying?* |
Medicine
Dentistry |
| Place
of study* |
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| Year of
study* |
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| Likely
year of graduation* |
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| Part 3
- about GLADD services for members |
There are currently several
ways to keep in
touch with GLADD members online, and unless
you instruct us otherwise we would like to sign you up to all three, listed
below.
To keep well informed about what's happening in GLADD, we'd
recommend you join GLADD-L and the Forum since these are the main ways
that information about events is distributed. |
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GLADD-L is an e-mail discussion list exclusively available for GLADD members,
enabling you to discuss issues of concern to yourself and other members and
also to receive rapid updates about GLADD activities.
If you do not want to join GLADD-L automatically, please check this box
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The GLADD Forum has been started recently. It's an online noticeboard and discussion
area which makes it easier for members to talk about a range of different
topics. Note that by joining the GLADD Forum, your name will be visible to
other members of GLADD within the site.
If you do not want to join the GLADD Forum automatically, please check this box
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If you live outside of London, there are a number of regional
groups of GLADD members who meet up on an informal social basis. If
you do not want us to pass your details on to the GLADD member who organises
these events in your area, please check this box
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| Part 4
- how you would like to pay for membership |
| Please
choose a payment method* |
I would like to pay
by standing order (the default option). I understand that this significantly
reduces the amount of
administrative work GLADD has to do, and setting up a standing order takes
no more time than writing a cheque.
I would like to pay
by cheque. Please send me an invoice for my membership of GLADD for the
first year. I understand that will include a £5 surcharge to cover
the additional administrative costs incurred by GLADD. |
| Part 5
- confirming your request to join GLADD |
| Confirmation* |
By checking this box and pressing the submit application button
below, I confirm that I support the aims of the Gay and Lesbian Association of
Doctors and Dentists,
and agree to abide by the rules contained in the constitution. |
