The BSA

* Membership Type

Special Access Global Member Free for one year You must reside in a World Bank recognised low to middle income country. During application you will be asked to upload proof of place of work and place of residence e.g by providing a letter from your manager. Each year you will be asked for proof of residence to remain a free member. Excludes: Voting rights, eligibility to become a Trustee or a steering group member.

View World Bank recognised low to middle income countries pdf (Categories 1 & 2 recognised).

* Title

* First & Last Name

Initials

* Choose a Username

it must be 6 or more characters in length
may only contain letters, numbers, and underscores

* Choose a Password

must be 6 or more characters

* Confirm Your Password

* Your E-Mail Address

a confirmation email will be sent to you at this address

Please note your email address will be held as your primary contact and will be displayed on membership list. Students please use personal email and not University or NHS email.

* Phone Number

* Mobile Number

* Job Type

* Organisation Name

* Type of Organisation

Other type of Organisation

* Job Title

Work Department

Work Address Line 1

Work Address Line 2

Work Address Line 3

Work Address Town/City

Work Address County

Work Address Country

Work Address Postcode

Work Telephone Number

Work Telephone Number extension

* Proof of Residence

Please provide/upload proof of residence (pdf)

* Proof of Work Place

Please provide/upload proof of your place of work (pdf)

I agree to my details displayed on membership list

Yes

* Why do you want to be a member of BSA

Please include a short personal statement supporting your application explaining why you want to become a member of the BSA. (200 words)

I consent to receive BSA emails

I consent to receiving emails from the BSA relating to non-BSA meetings, career opportunities and other advertising relating to audiology.

Yes
No

Be informed about non-BSA events?

Do you wish to be informed of non-BSA meetings arranged by other organisations and/or other documents relating to Audiology?

Yes
No

Special Interest Groups

Are you interested in becoming a member of any of the following special interest group?(please tick any of interest):

Adult Rehabilitation Interest Group
Auditory Processing Disorder Special Interest Group
Balance Interest Group
Cognition and Hearing Special Interest Group
Electrophysiology Special Interest Group
Paediatric Audiology Interest Group
Tinnitus and Hyperacusis Special Interest Group
Bone Conduction & Middle Ear Devices Special Interest Group

I give permission for my contact details to be shared with the relevant Chair(s) of Special Interest Group(s) I have indicated an interest in

Research Interests

Please indicate your Research Interests (tick all appropriate)

Global Outreach

Are you interested in hearing about Global Outreach and therefore being contacted by the Global Outreach Trustee?

Gender

Self-describe Your Gender

Ethnicity

White

Asian/Asian British

Mixed/Multiple ethnic background

Black/African/Caribbean/Black British

Other Ethnic Background

(please specify where other above)

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Referred by

Please confirm who referred you

* Code of Conduct

I can confirm that I am of good character and I agree to abide by the BSA’s Code of Conduct

The code of Conduct can be found by clicking here.

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BSA Special Global Membership Form