Membership Application Form
To apply for membership, simply fill out the information below and click the
Submit
button.
Personal Information
Title:
First Name (s):
Surname:
House No./Name:
Road/St Name:
Town/City:
County:
Postcode:
Home Tel:
Mobile:
Email:
Employment Information
Employers Name:
Job Title:
Employment Status:
Employed Full Time
Employed Part Time
Self Employed
Unemployed
Volunteer
Employment Type:
--- Please select ---
Public - Local Authority
Public - Fire and Rescue
Public - Police
Public - Health Service
Academic - Teaching
Private
Voluntary
None
Time in current post:
Years:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
Months:
0
1
2
3
4
5
6
7
8
9
10
11
Time in road safety position:
Years:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
Months:
0
1
2
3
4
5
6
7
8
9
10
11
Retirement Date (if applicable):
Day:
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month:
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year:
2020
2019
2018
2017
2016
2015
2014
2013
2012
2011
2010
2009
2008
2007
2006
2005
2004
2003
2002
2001
2000
1999
1998
1997
1996
1995
1994
1993
1992
1991
1990
1989
1988
1987
1986
1985
1984
1983
1982
1981
1980
pre 1980
Please provide a short resume (maximum 500 words) in support of your application:
I agree to the RSGB Academy
Terms and Conditions
Submit