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Title *

First name *

Last name *

Phone number *

Please use your home address

Address line 1 *

Address line 2

Address line 3

City *

Postcode *

Country *

What is your ethnicity?

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If you were referred by an existing member please name them

If you were referred by someone please add their name here.

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Name of Institution/Company/Charity *

Name of Department and or School

Job title

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We are curating a membership expertise list. Please tick all areas of your research.

Interests

Would you be happy for BISA to share your expertise with outside parties?

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I agree to the membership terms and conditions as published on the BISA website *

Yes

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