FCI Associate Application Form - 20 April 2023

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, full postal address and telephone number

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First Name

Surname

Email address

Telephone number

Address 1

Address 2

City

County

Post Code

Country

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* 2. Degrees and other relevant qualifications

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* 3. Profession

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* 4. Professional registration body (if held)

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* 5. Professional registration number (if held)

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* 6. Current role (s)

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* 7. Organisation (s)

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* 8. Previous roles

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* 9. Are you enrolled on or an alumni of, the National School of Healthcare Science Scientist Training Programme or Higher Specialist Scientist Training Programme, a Topol Fellow or a healthcare scientist working in the NHS?

Yes

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* 10. Are you applying as a Student?

Yes

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* 11. What interests you about clinical informatics?

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

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* 13. 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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* 14. Specific areas of Interest e.g. AI, Genomics, Personalised Care, Language and Terminology

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* 15. Would you be happy for your name to be shared on the Faculty website?

Yes

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* 16. Would you be happy for your details (name, profession, employer/status, areas of interest and membership of other organisations) to be included in a directory that can shared with other members? (This would not be available to non-members.)

Yes

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* 17. 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.

Yes

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* 18. Signed

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* 19. Date:

Date

Thank you for filling the application form. Please note your details will not be shared with any individuals or organisations without prior consent, in line with our privacy policy: GDPR Privacy Notice | Faculty Of Clinical Informatics