BIPOSA Membership application form

BIPOSA Membership
Membership is open to:

1. Ophthalmologists on the specialist register with a specialist interest in paediatric ophthalmology and / or strabismus, 2. Orthoptists. 3. We offer Associate membership to doctors training in paediatric ophthalmology, international ophthalmologists, doctors not on the specialist register with an interest in paediatric ophthalmology and / or strabismus, research doctors and scientists with interests in paediatric ophthalmology and / or strabismus
Completing the form

All the sections in the first part of the form must be completed. Click on the arrow to open the section relevant to you and then complete the section relevant to your application. Incomplete applications will not be considered.
Name*

First NameLast Name
Email address*
example@example.com
Your current base hospital / university*
your main hospital or university base
Your current job title / grade*
Your referee / sponsor who is a current BIPOSA member*
name of current BIPOSA Member
Are you applying for (check one option - then proceed to second part of the application form):*

full member, consultant on the specialist register with an interest in paediatric ophthalmology / strabismusfull member, OrthoptistAssociate Member

Click on the arrow and complete the section relevant to your application
Full Medical Member Application

Please provide your GMC number, details of the Paediatric, Strabismus Fellowship or ASTO you have undertaken, and the number of paeds/ strab sessions you undertake weekly in your current role
Your GMC Number*
Name of your Fellowship Supervisor
Year you undertook your Fellowship
Hospital or Institution where you undertook your Fellowship
where you undertook your fellowship
Current number of paeds sessions per week
Current number of strabmisus sessions per week
Full Orthoptic Members

Please provide details your grade and summary of work plan
Grade
not paygrade
HPC Registration Number or equivalent if based in Ireland*
Your year of qualification
Brief description of your weekly work plan
Associate Member

Please select your current status then provide a brief summary of your role. If you are a fellow please detail your current supervisor and post; if you are an overseas ophthalmologist please give details of your paediatric / strabismus fellowship and the number of sessions you undertake per week
Your current job title / grade
GMC Registration Number or equivalent professional body
How many paeds or strabismus sessions do you undertake each week?
What relevant training or clinical practice do you have in paeds or strabismus
Provide details of any paeds or strabismus fellowship you have undertaken or are currently undertaking including the name of your supervisor and the host institution
Any other supporting information towards your application
I declare that I am a person of good standing and there are no restrictions on my medical practice*

I confirmI cannot confirmI have restrictions placed on me
Signature

Clear
Dated

MonthDayYear
Date

BIPOSA will check the information you have provided. Once we have received your application the Executive will consider your application. We will email a notification to you. Once approved your membership becomes valid on payment on the membership fee. I confirm that I have read I accept the membership application terms*

yesno
Take photo or upload photo if required to be added to your membership profile (once approved)
Should be Empty:

BIPOSA Membership

Membership is open to:

Completing the form

Full Medical Member Application

Full Orthoptic Members

Associate Member