Student Application Form
Faculty of Forensic and Legal Medicine of the Royal College of Physicians
1 White Horse Yard
78 Liverpool Road
London
N1 0QD
Student Affiliate Membership Criteria
Student Affiliate Membership with the FFLM entitles the individual to the full range of academic, educational and other
facilities available to full Members. The distinction is that Student Affiliate Members do not have voting rights and are
not able to use their Student Affiliate Membership as a designator.
Student Affiliate Membership with the FFLM is open to those who:
1. Are full-time students enrolled at an accredited university.
2. Are studying in a field and at an educational institution that the Board determines is appropriate for the purpose of
Student Affiliate Membership.
Correspond
Personal Details
Title:
Forename:
Middle Name:
Surname:
Date of Birth:
Gender:
Contact Details
Daytime contact no:
Mobile No:
Email:
Correspondence Address
Address Line 1:
Address Line 2:
Town/County:
County/State:
Postcode/Zip code:
Country:
Education
University or other higher education institution:
College or medical school:
Course title:
Degree/diploma which course leads to:
Year course commenced:
Date course due to end:
Existing degrees
Degree
Year
University
Bachelor
Masters
Doctorate
Diploma
Registration with a regulatory body
Yes
No
If yes, regulatory body: GMC/GDC/NMC/HCPC or
Other (State name)
Registration number:
Anticipated date of full registration (e.g. end of FY2) :
Membership or affiliation with other medical Royal
colleges or faculties:
Previous work experience in law or forensic or legal
medicine:
Work in forensic or legal medicine aspired to:
What to do now
Please return your application form to info@fflm.ac.uk or alternatively to the address below, to process this application.
Membership, Faculty of Forensic & Legal Medicine
1 Whitehorse Yard, 78 Liverpool Road, London N1 0QD