Full Hair Transplant Surgical Assistant Membership Application Professional DetailsTitle:*DrMrMrsMissOtherOther Title:Name* First Last Date Of Birth:* Name of Hair Transplant Clinics where you currently work and name of Hair Transplant Surgeons that you currently work with*Clinic Address* Street Address Address Line 2 City ZIP / Postal Code Clinic / Work Tel No:*Clinic e-mail address:Clinic / Work Website: Qualification & DatesQualifications*HAIR TRANSPLANT EXPERIENCEHow long have you been assisting with hair transplants?*Where did you initially train as a hair transplant surgical assistant?*How many hair transplants have you assisted with?*How many hair transplants do you assist with per month (on average)?*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 address:* This is the email address for all correspondence with the BAHRS, please ensure it is secure as we sometimes send sensitive information.Tel No:*Referee's name:*NB: Referee must be a hair transplant surgeon who is a BAHRS member and who employs you or is employed by the clinic where you workDate* I confirm that I have read and understood the BAHRS Membership Terms and Conditions, the BAHRS Professional Standards for Hair Transplant Surgical Assistants, and the BAHRS Code of Conduct for Full Hair Transplant Surgical Assistant 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 Your application will not be processed until confirmation of support from the referee is received at email@example.com An invoice will be sent for the annual membership fee upon approval. NB. Annual membership runs for 12 months from date of payment.