British Teledermatology Society

British Teledermatology Society - Membership Form

Please complete the following form in BLOCK CAPITALS, print, sign and send to:
David de Berker, Bristol Dermatoloy Centre, Bristol Royal Infirmary, Bristol BS2 8HW

Surname
Forenames
Title
Date of Birth
Nationality
Speciality
Status
Qualifications
Main Hospital
Post Held
Home Address
Postcode
Telephone
Fax
Preferred Mailing Address	Home Work
Signed
Date

about l objectives l factors for success l setting up l data l legal aspects l image technology
patient pathway l evaluation l online resources l authorship l BAD working party 1999
patients l members l affiliated groups l doctors l general