PLEA Membership Application

On completion of this application form, you will be taken to our payment partner Worldpay, to make your initial subscription payment. Without payment, your application will not be completed. Thank you.

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Application Type

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Member Profile

Title
Firstname	(required)
Surname	(required)
Address 1	(required)
Address 2
City	(required)
County
Postcode/Zip	(required)
Country
Email	(required)
Work Telephone	(required)
Home Telephone
Mobile Number

Qualifications and Credentials

Job Title
Academic and Professional Qualifications
GPhC Registration No.
RPS Membership No.
Other Membership Details

Practice Area(s) (tick all that apply)

	Academia teaching
	Academia research
	Barrister
	Civil servant or government service
	Community practice
	Consultant
	Education and training
	Health service management
	Hospital practice
	Industrial practice
	Journalism
	Pharmacy organisation or body
	Pre registration pharmacist
	Public health
	Retired
	Solicitor
	Pharmacy student
	Other
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