Please note. All fields marked with an asterisks (*) are required.
If you work at more than one clinic, please put your main clinic here, you will have opportunity to add further clinics in your Member profile once your application has been accepted
Personal Contact Details
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.
NB: Referee must be a BAHRS surgeon member
Your application will not be processed until confirmation of support from the referee is received at firstname.lastname@example.org