Clinical registration is not required for Associate membership, and the Faculty is eager to encourage anyone with an ongoing enthusiasm and engagement in clinical informatics. If you would like any advice or guidance on completing your application, please contact info@fci.org.uk.

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* 1. These details will be removed from your application before it is sent to the assessment panel. Your application will be anonymous, but could be identifiable via any specific experiences you describe or reference to publications that you provide. Please let us know your name, contact email and telephone number

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* 2. Degrees and other relevant qualifications

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* 3. Professional registration body and number (if held)

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* 4. Current role (s)

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* 5. Previous roles

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* 6. Are you currently enrolled on the NSHCS/HEE Scientist Training Programme or Higher Specialist Scientist Training Programme?

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* 7. What interests you about clinical informatics?

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* 8. Why do you want to join the Faculty of Clinical Informatics?

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* 9. Describe your experience in clinical informatics and any steps you have taken to further your knowledge in the subject. Examples may include, but are not limited to, undertaking e-learning in informatics, or being involved in an informatics related project.

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* 10. Declaration: I understand that if elected as an Associate I will be required to contribute an annual fee to the Faculty of Clinical Informatics. This is currently set at £51 per annum. Other pricing options are available based on income.

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* 11. Signed 

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* 12. Date:

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