THE SOCIETY FOR CARDIOLOGICAL SCIENCE AND TECHNOLOGY

Application to enter the

SCST Awardin Practical Electrocardiography

Entry Fee £60

The Examination will be held on the Saturday 6th September 2014

The closing date is27th June 2014, applications received after this date will NOT be accepted.

IMPORTANT

This application form is valid only for the date shown above and will NOT be accepted if it is altered to any other date.

(Please print clearly using BLOCK CAPITALS and fill in ALL sections of the form)

SURNAME ...... ( Mr / Mrs / Miss / Ms ) JOB TITLE …...... ….………

FIRST NAMES......

MAIDEN NAME …………………………………………………………………..Date Of Birth…………………………………….

ADDRESS (To which ALL correspondence will be sent, preferably not your hospital)

......

……...... ……...... POST CODE ……...... ……….

Telephone Number ...... ………...……… SCST Membership number ………………………….

HOSPITAL ......

Department ……………………………………………Hospital Telephone Number …………………………………..

Email Address…………………………………………………………………………………………………………………………..

Please tick as appropriate:-

Syllabus required Receipt required

£10 Charge

EXAMINATION CENTRE- BIRMINGHAM ONLY

Please send the completed form to:

SCST, Executive Business Support (EBS), City Wharf, Davidson Road, Lichfield, Staffordshire WS14 9DZ

The Society for Cardiological Science and Technology (SCST) is the professional body for Cardiac Physiologists and Cardiographers. SCST seeks to promote good professional practice and standards throughout Cardiology. An individual is entitled to apply for membership of SCST if they are actively working in the field of cardiology, either as a Cardiac Physiologist, an Associate Practitioner in Cardiology or as a Cardiographer. Membership forms to join the Society as a pre-enrolled member are available on the SCST website.

There are two Electrocardiography examinations available through SCST:-

TheCertificate in Electrocardiography(Written and practical assessment) is suitable for Cardiographers, Senior Cardiographers, ATOs (Assistant Technical Officers) in Cardiology and Senior ATOs. See syllabus on SCST website.

TheSCST Award in Practical Electrocardiography (recording only) is appropriate for any healthcare professional who is involved in recording 12-lead ECG's.

[ Official use only below this line ]

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