Professional Partner Membership

Membership *

Professional Partner Membership - Pro-rata: May to Dec - £ 33.33

Total Amount

Account

Please enter a Username to create an account. If you already have an account please login before completing this form.

Username *

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Punctuation is not allowed in a Username with the exception of periods, hyphens and underscores.

Password

Confirm Password

Provide a password for the new account in both fields.

Personal Details

Individual Prefix *

First Name *

Last Name *

Street Address (Primary) *

Supplemental Address 1

Supplemental Address 2

City *

Post Code *

County

Country *

Email address must be an individual account which you have sole access to.

Email (Primary individual account) *

Phone *

My billing address is the same as above

Billing Name and Address

Billing First Name *

Billing Last Name *

Street Address *

City *

Country *

State/Province *

Postal Code *

Professional Partner Membership information

The fields below without an asterisk are optional information which helps SOM to ensure that its services meet the needs of all members

Non-OH Profession *

What organisation do you work for? *

How did you hear about us? *

What is your reason for joining? *

Birth Date

Gender

Specify your gender

Sexuality

Self-identify your sexuality

Ethnicity

Specify your ethnicity

I agree that my personal data will be used so that the SOM can contact me regarding membership

Comms Opt-In

Confirm

I confirm that I am not a health professional *

Yes No

Membership shows a commitment to workplace health and a wish to understand current best practice; but is not an endorsement by SOM of the services you may offer and does not provide SOM membership voting rights.

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