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Associate by DD

Associate by DD
Please enter a Username to create an account. If you already have an account please login before completing this form.
Name, Address and Email
Email address must be an individual account which you have sole access to.
You should not continue with this form if any of the following apply:
  • You are not the account holder.
  • If it is a business account and more than one person is required to authorise debits on this account.
Direct Debit Information
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Billing Name and Address
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Membership information
If 'Other' is selected, please state here:
The optional information below will help SOM to ensure that its services meet the needs of all members.
I declare that the above information is true. I am in good standing with my professional regulators or relevant governing body and I am not subject to supervision and/or restrictions on my practice, nor the subject of any proceedings pending against me. I understand that being a member of the SOM does not confer entitlement to any post-nominal qualifications or use of the SOM logo. I understand that membership may be withdrawn if I act contrary to the charitable objectives of the SOM.
I agree that my personal data will be used so that the SOM can contact me regarding member benefits such as e news, renewals, regional and national events and job alerts and give my permission for my information to be passed to Oxford University Press so that I can receive the Occupational Medicine Journal, and to James Hallam so that I can be contacted about Nurse Indemnity Cover, if applicable. You are free to update preferences within the member area.
Agreement Your account data will be used to charge your bank account via direct debit. While submitting this form you agree to the charging of your bank account via direct debit.