Membership Form Online

Name*
Address
Street Address Address Line 2 City ZIP / Postal Code
Phone number*
Email*
Employer*
Job Title / Description*
Applications may not be accepted if your job description does not support our training /educational content. All applications are subject to our Membership Secretary’s discretion.
Work Phone
I am applying for:*
- Full Membership
- 1 year post Retirement Membership
Date of Retirement
DD slash MM slash YYYY
Work Email
Method of Payment*
- I will send payment by BACS - Reference = Your Name
- I will send payment by cheque
Data Privacy*
- I consent to my submitted data being collected and stored
This form collects your personal data so that our team can communicate with you and provide you with assistance. Please check our privacy policy below to see how we protect and manage your submitted data.

All correspondence will be sent via email to reduce workload and stationary / postage costs

Membership runs from May and is for renewal the following May at our AGM .
If you join after this date you will not receive a full 12 months membership.

Please send payment of £25.00 by BACS to:
Nat West Bank
Account name: South East Essex Practice Nurse Group ( SEEPING)
Sort code: 55-50-28
Account number: 94716870
IMPORTANT: PLEASE REFERENCE PAYMENT WITH YOUR FULL NAME

Alternatively please send a cheque for £25.00 payable to
South East Essex Practice Nurse Group
to
Dee Sarchet. 250 Greensward Lane. Hockley SS5 5JN

If you prefer a hard copy, please contact us and request a form

The information supplied on this form will be kept in the strictest confidence.

Download a Membership Form here

Website Privacy Policy

We take your privacy very seriously and are responsible in complying with the Data Protection Act 1998. Please read this policy as it contains information about data we collect and how it is used.

Membership

Membership Form Online

Applications may not be accepted if your job description does not support our training /educational content. All applications are subject to our Membership Secretary’s discretion.

Website Privacy Policy