UKPIN

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Membership Application Form

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Membership Application Form

All nurses, scientists and medical practitioners in the United Kingdom who are involved in the healthcare of patients with primary immune deficiencies or research into these diseases are eligible to be members of UKPIN.

If you wish to join please read the UKPIN constitution, available here, and fill out the form below.

Forename:
Surname:
Professional title: (Eg. Consultant Immunologist, etc.)
Work Address Department:
Institution:
Address Line 1:
Address Line 2:
City:
Post code:
Telephone number:
Fax number:
Email:
I agree to UKPIN storing the above details in its membership records for reference purposes on the understanding that these details will not be disclosed to any third party.
I agree to the following details being posted in the Membership section of the UKPIN website:
Name:	Yes No
Work address:	Yes No
Telephone:	Yes No
Fax number:	Yes No
Email:	Yes No
By submitting this form I confirm my eligibility for UKPIN membership and agree to the constitution of the Network as placed on the UKPIN website. I will uphold standards of probity and propriety as such a member and will assist in furthering aims of the Network.

Where consent is given, individuals details are displayed in the members section of the UKPIN website. UKPIN will not pass your details on, either actively or on request, to any third party at any time.