Development Page

Membership Application Form

 

Before you complete this form, please note that you require a proposer and seconder both of whom must be Freemen of the Company of Nurses

If you require any assistance with this please email enquiries@companyofnurses.co.uk

Current Role

(Please tick those boxes which best describes your current role)


Previous Areas of Speciality

Please tick those boxes which best describes your previous role/s


Access Requirements


Other Livery Companies


Proposer and Seconder

Please note that your proposer and seconder must be Freemen of the Company of Nurses. 


Type of Membership

(Please tick type of membership required)


To: Lloyds Bank

Sort Code: 30-92-92

Account No: 3294 7968

Account Name: The Company of Nurses

Reference: Please use your surname and 2 initials eg. Smith E C

I have paid by cheque made payable to: The Company of Nurses

Please send the cheque to: 

The Honorary Clerk, The Company of Nurses, Apothecaries' Hall, Black Friars Lane, London, EC4V 6EJ

I confirm that the information contained within this application form is accurate to the best of my knowledge and I give permission to the Company of Nurses to contact and communicate with me via email, telephone, text and post. I confirm that I have never been declared bankrupt and that I have no criminal convictions. I confirm that I have not been struck off the NMC register.

I agree to inform the Company of any changes in my circumstances to clerk@companyofnurses.co.uk

I give my explicit permission for the Company of Nurses to hold, process and share internally and with the City of London Corporation my personal data, as contained in this form.

 

Monitoring Information


Ethnic Group


Asian or Asian British

Black, African, Caribbean or Black British

Mixed or Multiple Ethnic Groups

White

Other Ethnic Group

How would you best describe your national identity? Tick all that apply.

What is your gender ?

Does your gender identity match your sex as registered at birth (or within 6 weeks) ?

Which of the following options best describes your sexual orientation ?

What is your religion or belief ?

Disability

The Equality Act 2010 defines a person as disabled if they have a physical or mental impairment, which has a substantial and long-term (i.e. has lasted or is expected to last at least 12 months) negative adverse effect on the person’s ability to carry out normal day to day activities.

Do you consider yourself to have a disability according to the definition above ?

If yes, please state the impairment which applies to you

Please press submit and thank you for completing the form