APPLICATION FORMEMBERSHIP

The Association of Anaesthetists of Great Britain & Ireland

2015 – 2016 Membership Year

PLEASE USE BLOCK CAPITALS

Title: / Forenames: / Surname:
GMC/IMC Number:
For Anaesthetists wishing to join the AAGBI who are based overseas and do not have a GMC/IMC number, please send in a pdf./copy showing your proof of employment letter at your current hospital, along with your completed application form.
I offer my name as a candidate for membership (please mark the appropriate category) see notes overleaf.
Ordinary & Associate
Salary greater than £40,000 / €45,000
Ordinary & Associate
Salary less than £40,000 / €45,000 / Medical Student (please state your year)e.g. Yr 5
Ordinary & Associate
Salary less than £20,000 / €22,500 / Pre ST3 (FY/CT/ACCS)
SAS Grade
(New discounted rate!) / ST 3
Joint / ST 4
Overseas / ST 5
Overseas Limited Income / ST 6 +
Retired (receiving Journal & Anaesthesia News) / Trainee Overseas
Retired (receiving Anaesthesia News only) / Trainee Overseas Low Resource Country*
Maternity Leave
Date of Birth: / Gender: Male/Female:
Qualifications/Honours (with dates)
Job Title: e.g. FY1/ FY2/ ACCS 1/ ACCS 2/ ACCS 2+/ CT1/ CT2/ ST3/ST4/ST5/ ST6/ Consultant/Staff Grade/Specialty Doctor
Correspondence address:
Postcode:
Email address:
Mobile: / Home Phone:
Hospital Name: / Hospital Phone:
I apply to be a member of the Association of Anaesthetists of Great Britain and Ireland and the AAGBI Foundation and agree to abide by the terms set out in their regulations. ( )
Signed: Date:

SUBSCRIPTION RATES

The membership year runs from 1st July 2015 – 30th June 2016

After 1st January 2016, these subscriptions will be reduced by 50% for the remainder of the membership year

Ordinary/Associate/SAS/Joint/Overseas & Retired / Trainee Members
Ordinary/Associate – salary greater than £40,000 / £263/€ 364.91 / Medical Student / £26 / € 36.08
Ordinary/Associate – salary less than £40,000 / £136 /€ 188.70 / Pre ST3 - FY/ CT/ ACCS / £60 / € 83.25
Ordinary/Associate – salary less than £20,000 / £84 /€ 116.55 / ST 3 / £92 /€ 127.65
SAS Doctors (1st year of membership) / £84 / € 116.55 / ST 4 / 5 / £120 /€ 166.50
SAS Doctors (2nd year of membership) / £168 / € 233.10 / ST 6+ / £152 / € 210.90
Joint Ordinary / £195 /€ 270.56 / Overseas Trainee / £152 / € 210.90
Overseas Ordinary / £206 / € 285.83 / Overseas Trainee Low Resource Country* / £25
Overseas Low Income / £85 / € 117.94 / Euro members may pay their subscription in Euros, please mark if you wish to pay in Euros.
□
Retired - receiving Journal & Anaesthesia News / £39 /€ 54.11
Retired - receiving Anaesthesia News only / £24 /€ 33.30
Maternity Leave / £39 /€ 54.11

*As defined by the World Bank

HOW TO APPLY FOR MEMBERSHIP

  1. Complete the application form overleaf.
  2. Include your GMC or IMC number. For Anaesthetists wishing to join the AAGBI who are based overseas and do not have a GMC/IMC number, please send in a pdf./copy showing your proof of employment letter at your current hospital, along with your completed application form.
  3. Send this application form with a completed direct debit form(download from the website ) to:

Membership Department, Association of Anaesthetists, 21 Portland Place, London W1B 1PY.

If you are not based in the UK or Ireland you will not be able to pay by direct debit, you will however be able to pay online once your membership is established.

  1. PLEASE DO NOT FORGET TO SEND PAYMENT WITH THIS FORM. APPLICATIONS WILL NOT BE PROCESSED WITHOUT INCLUDING PAYMENT.
  2. Please telephone 020 7631 8801 or email f you have any questions about your subscription rate or applying for membership.
  3. On payment of the due subscription, you will become entitled to the benefits of membership.