SCOTTISH STROKE AHP FORUM
Membership Request Form
Membership to the Scottish Stroke AHP Forum (SSAHPF) is for Allied Health Professionals including AHP support workers and students (final year undergraduates and post graduates) with an interest in stroke and working in Scotland.
Membership is free. Joining is easy. Simply complete this short form and return it to the SSAHPF Secretary (details at the end of the form). Your details will then be held on a secure database. Please note students will need to re-apply for membership each year.
As a member, periodically you will be sent information relevant to stroke via email.
Your details will not be passed on to any third Parties.
Title (underline): Mr Mrs Miss Ms Dr Prof Rev
First Name: Surname:
Organisation/Address:
Postcode:
Telephone:
E-mail (mandatory):
University (if student):
Health Board Area (tick one)
Ayrshire & Arran □ Lanarkshire □
Borders □ Lothian □
Dumfries & Galloway □ Orkney □
Forth Valley □ Shetland □
Fife □ Tayside □
Grampian □ Western Isles □
Greater Glasgow & Clyde □ Scotland wide □
Highland □ Other (specify) □
Main Areas of Work (tick up to 3 most relevant)
Clinical Practice □ Support Worker □
Management/Leadership □ Student □
Research □ NB: Student memberships will be deleted after a year
Education □ Other (specify) □
Quality/Audit □
Profession (tick one)
Arts Therapies □ Paramedicine □
Audiology □ Prosthetics □
Dietetics □ Physiotherapy □
Occupational Therapy □ Podiatry □
Orthoptics □ Radiography □
Orthotics □ Speech & Language Therapy □
Other (specify) □
I hereby request to become a member of the Scottish Stroke Allied Professionals Forum and accept the conditions as detailed:
Name Date
Thank you for completing this form.
Please return by email to: (preferred)
Or by post to: Wendy Juner, Secretary, Scottish Stroke Allied Health Professionals Forum
Address: Physiotherapy Department, St Johns Hospital, Howden Road West, EH54 6PP.
The SSAHPF is kindly supported by Chest Heart & Stroke Scotland and The National Advisory Committee for Stroke.