RD-UK Membership

Please complete the online application form and you will be contacted by email when the subsequent subscription is due. Annual subscription rate of £40.

Please also complete a

• Standing Order Form  (Opens in a new window)

and forward this to the RD-UK Honorary Secretary.

Online Application

Please do not disclose confidential information when contacting us via this website or by email.

Contact Details

Title Select OneMsMissMrsDrProfMr

Surname

First Name

Alternative Surname

Gender

 Male

 Female

Date of birth12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034203520362037203820392040204120422043204420452046204720482049205020512052205320542055205620572058205920602061206220632064206520662067206820692070207120722073207420752076207720782079208020812082208320842085208620872088208920902091209220932094209520962097209820992100

Email Address*

Home Address

Home Telephone

Main Base / Practice Address

Main Base / Practice Telephone

Other Centres Address

Other Centres Telephone

Preferred Address for Correspondence

 Home Address

 Main Base / Practice Address

 Other Centres Address

Professional Details

GDC Number

Degrees

Year of (Primary) Qualification

Membership Category

 Please select one

 Full Member

 Trainee Member

Trainee Member Details

If Trainee, please indicate expected date of accreditation

Trainee Specialty

Please check all that apply

 Restorative Dentistry

 Endodontics

 Periodontics

 Prosthodontics

Consultant and / or Specialist Member Details

Honorary or NHS Appointment W.T.E

Year Appointed as Consultant12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034203520362037203820392040204120422043204420452046204720482049205020512052205320542055205620572058205920602061206220632064206520662067206820692070207120722073207420752076207720782079208020812082208320842085208620872088208920902091209220932094209520962097209820992100

Registered Specialist?

 Yes

 No

Year of first entry on Specialist Register (if applicable)12345678910111213141516171819202122232425262728293031 JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember 1920192119221923192419251926192719281929193019311932193319341935193619371938193919401941194219431944194519461947194819491950195119521953195419551956195719581959196019611962196319641965196619671968196919701971197219731974197519761977197819791980198119821983198419851986198719881989199019911992199319941995199619971998199920002001200220032004200520062007200820092010201120122013201420152016201720182019202020212022202320242025202620272028202920302031203220332034203520362037203820392040204120422043204420452046204720482049205020512052205320542055205620572058205920602061206220632064206520662067206820692070207120722073207420752076207720782079208020812082208320842085208620872088208920902091209220932094209520962097209820992100

Specify Registers

Please tick all that apply

 Restorative Dentistry

 Endodontics

 Periodontics

 Prosthodontics

If you are on more than one register please give the dates added to each register below

Fields of work

Both Full members and Trainee Members please check all that apply,

 Consultant

 NHS Practice

 Private Practice

 Hospital Dental Service

 Community Dental Service

Data Consent

 Please check this box to confirm your details are correct

1.Email correspondence

Email Contact  I consent to receiving email correspondence

2. Subspeciality Databases

I consent for my details to be held on specific subspecialty databases e.g. head and neck subgroup (where applicable)  I consent for my details to be held on specific subspecialty databases

3. Please select what you are happy to be contacted about:

I am happy to be contacted about:

 General RD-UK news

 Events run by RD-UK

 Events run by other external organisations

 Relevant job vacancies

 Invitations to participate in surveys

Please confirm that you are not a script by entering the letters from the image.

Download PDF Forms

Please download the following PDF forms  - these forms open in a new window.

• Standing Order Form - send to your bank

If you don't already have a PDF reader, download and install the free Adobe Reader