ASPiH Membership Form

* Membership Type

Individual Membership £80 Annual Subscription
Student Membership £40.00 for one year
Add Additional Institutional Members [LEGACY £400 Institutional Memberships only] Seats at £40 each (ends when Institutional Membership ends)
Institutional Membership [Standard Tier] (+ 2 Members) £480.00 for one year Membership for Institutions with two memberships included (the lead member signing up for this membership counts as one of these members)
Add Additional Institutional Members [Standard Tier] Seats at £60 £60.00 for one year
Institutional Membership [Premium Tier] (+ 4 Members) £720.00 for one year Membership for Institutions with four memberships included (the lead member signing up for this membership counts as one of these members)
Add Additional Institutional Members [Premium Tier] Seats at £50 £50.00 for one year

* Payment System

Credit / Debit Card Payments Via Stripe Secure Payment Processor PO Payments (on requested only) Payments requiring a PO number (payment via BACS)

PO Number

(only for institutions and members needing to pay using a PO Number, invoice, BACs payment)

* CCT Date (Trainees only)

* Title

* First & Last Name

Telephone

* Your E-Mail Address

a confirmation email will be sent to you at this address

* Choose a Password

must be 6 or more characters

* Confirm Your Password

Institution Contact Name

(for Institutional Membership only)

Institutional Contact Email Address

(for Institutional Membership only)

* Institution / Organisation Name

(for Institutional Memberships only)

* Address Line 1

Address Line 2

* City

* Country

* County / Region / State

* Postcode / ZIP

* Job Title

* Profession

* Role / Position

(Please select)

Any Other Specialty?

* Employing Organisation

* Employing Organisation Location

ASPiH accreditation

Please indicate if you are considering or intend to submit an application for ASPiH accreditation in the near future by selecting one of these options:

Individual
Organisation
No current intention

* Are you a member of any other associations?

Association of Standardized Patient Educators (ASPE)
International Nursing Association of Clinical Simulation and Learning (INACSL)
International Pediatric Simulation Society (IPSS)
Irish Association for Simulation (IAS)
Society for Simulation in Healthcare (SSH)
Society for Simulation in Europe (SESAM)
I am not currently a member of another simulation association
Other (please specify)

Other Association

(please specify)

* Would you like to be contacted about joining a Special Interest Group (SIG)?

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