Down Syndrome Medical Interest Group (DSMIG)
Membership Application Form
DSMIG is a network of health professionals whose aim is to help promote equitable provision of medical care for all people with
Down syndrome in the UK and Ireland by disseminating a wide range of information about the medical aspects of the
syndrome and promoting interest in its specialist management.
Membership is open to healthcare professionals who have a specialist interest in the syndrome and are prepared to be
proactive within the group. All applications need to be sponsored or approved by a steering group member. If you do not
currently have any links with a Steering group member please contact us to discuss your application. Applications are also
welcomed from non-healthcare professionals from national groups working with people with Down syndrome, and students or
researchers who may join as Associate Members.
For further details about DSMIG and online membership applications please see www.dsmig.org.uk.
Annual membership is £30.
If you would like to join the group please complete the following, writing as clearly as possible, PLEASE DO NOT SEND
ANY MONEY UNLESS YOUR APPLICATION HAS ALREADY BEEN CONFIRMED.
Name
Professional registration number e.
GMC/UKCC please specify
Post held
Work Address
Mailing Address
(if different)
Tel.
Email
What are your own interests relating to Down Syndrome? Are you involved in a service providing care for people with
Down Syndrome?
How do you hope to benefit by membership of DSMIG?
What would you hope to contribute to DSMIG?
Have you any research/audit (planned, in progress, or completed), which you think would interest the group?
Do you have a steering group sponsor?
Yes / No. If ‘Yes’ please give name.......................................................
My application has been confirmed therefore I enclose a cheque for £30 payable to DSMIG
My application has not yet been confirmed therefore no cheque enclosed
If my application is successful, I consent to my details (Contact details/Special Interests/Clinics/Audit/Research) being
included on the Members’ list of the DSMIG website
Yes/No
Signature……..………..………………………………….Date...........................................................
Please return this form to:
Joyce Judson, DSMIG Secretary, Children’s Centre, City Hospital Campus, Hucknall Road, Nottingham. NG5 1PB.
Tel 0115 883 1158
( REF V- 2015)