Affiliate Hair Transplant Surgeon Membership Application Professional DetailsTitle:*DrMrMrsMissOtherOther Title:Name* First Last Date Of Birth:* Occupation:*Hair Transplant Clinic name*Clinic Address* Street Address Address Line 2 City ZIP / Postal Code Clinic Tel No:*Clinic e-mail address:Clinic / Work Website: QualificationQualifications*GMC Registration No:*On surgical specialist register or performing hair transplant surgery prior to April 1 2002?*YesNoHAIR TRANSPLANT EXPERIENCEHow long have you been performing hair transplants?*How many hair transplants have you performed?*How many hair transplants do you perform per month?*Personal Contact DetailsMailing Address* Street Address Address Line 2 City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Personal e-mail:* This email address will be used for all communications with the BAHRS. From time to time sensitive information will be sent to this address, please ensure it is secure.Tel No:*Referee's name:*NB: Referee must be a hair transplant surgeon who is a BAHRS memberThe BAHRS member who recommended I join the BAHRS:I confirm that I have read and understood the BAHRS Membership Terms and Conditions, the BAHRS Professional Standards for Hair Transplant Surgeons, and the BAHRS Code of Conduct for Affiliate Hair Transplant Surgeon Members, and agree to abide by them.* Yes Your data will not be shared with any third party, and the principles of the GDPR 2018 and will be adhered to. The BAHRS will use your personal data for the purposes of your involvement in Association activities. I understand that by submitting this form I am consenting to receiving information about the BAHRS by post, email, online or by phone.* YES Date* Your application will not be processed until confirmation of support from the referee is received at firstname.lastname@example.org An invoice will be sent for the annual membership fee upon approval. NB. Annual membership runs for 12 months from date of payment.