National Staff Grade and Associate Specialists Group

National Staff Grade and Associate Specialists Group: www.nsasg.org.uk

Membership application form

You will need to print this form off and send to address below

name	........................................................................
address	........................................................................ ........................................................................ ........................................................................
email	........................................................................
telephone	........................................................................
post (please ring)	staff grade associate specialist other (specify)..............
medical speciality	........................................................................
I want to come to the first meeting (please ring) later this year	yes / no (will be a Saturday morning, probably in Birmingham)

Aims..what issues do you want the group to address

the first aim of the group should be

........................................................................

the second aim of the group should be

........................................................................

the third aim of the group should be

........................................................................

the main problem with the new contract for me is

........................................................................

the second problem with the new contract for me is

........................................................................

the third problem with the new contract for me is

........................................................................

Please print off this form and send to

David Kinshuck,
National Staff Grade and Associate Specialist Group,
Eye Department,
Good Hope Hospital,
Rectory Rd,
Sutton Coldfield, B75 7RR

email queries etc to david.kinshuck (at) heartofengland.nhs.uk (replace (at) with @)

page prepared December 2007