Application for Full Membership
Personal details – please write clearly
Title
Surname
Forename(s)
Job Title
Grade
Specialty
Dr / Mr / Mrs / Ms / Other
Address for
correspondence
Postcode
Work address
(if different from above)
Postcode
Daytime telephone no.
Email address
Mobile no.
Second email address
(if applicable)
Professional details
GMC
Registration number:
NMC
Registration number:
GDC
Registration number:
HCPC
Registration number:
Other (please specify)
Registration number:
Are you an Instructor for any RC (UK) courses (e.g. ALS)?
If ‘YES’ please give details below
Organisation:
Yes 
No 
Qualifications
Experience in the field of resuscitation
Application for Full Membership
December 2014
Resuscitation Council (UK)
Tel: (020) 7388 4678 | Fax: (020) 7383 0773
enquiries@resus.org.uk | www.resus.org.uk
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Please state your reasons for wishing to join the Resuscitation Council (UK)
Please list relevant publications / research projects which you have led
Are you currently an Associate Member of the
Yes 
Resuscitation Council (UK)?
Start date of membership (if applicable)
Are you a member of the European
Yes 
Resuscitation Council?
If you are a member of any other professional body please give details below:
Signature
No 
No 
Date
Payment details
Full membership: £25 pa (£20 for RC (UK) accredited Instructors)
Payment methods (Please tick as appropriate)
□ Payment by cheque:
□ Payment by credit/debit card:


Please send your cheque for £25 (£20 for RC
(UK) accredited Instructors) payable to ‘The
Resuscitation Council (UK)’ together with this
application form.
Payment by card will be taken after approval. We
will contact you for your card details.
Subsequent years’ subscriptions should be paid by standing order. We will send you further details once your application
has been approved.
Please return this completed form to:
The Executive Director
Resuscitation Council (UK)
5th Floor, Tavistock House North
Tavistock Square
London WC1H 9HR
Date received
Payment by
Outcome
For RC (UK) use only
Reviewed by
Debit/credit card 
Cheque 
Cheque No.
Successful 
Unsuccessful 
Application for Full Membership
December 2014
Resuscitation Council (UK)
Tel: (020) 7388 4678 | Fax: (020) 7383 0773
enquiries@resus.org.uk | www.resus.org.uk
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