specialist membership with 4everlearning.com

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Signing up and paying for your Specialist membership

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Signing up and paying for your Specialist membership is fast, simple and secure. Please make sure you have your credit card details to hand ready for Screen 3....

Please provide us with your personal and Specialist details by filling in the form below. Your membership will be confirmed via email sent to the address below. You will then be provided with login details that will allow you to amend and add to your details.

* =Required field

Title:

First Name:

Surname:

Address at which you accept referrals:

Postcode:

Country:

Telephone:

Fax:

Email address:

Qualifications:

Practice Name:

GDC No:

Select all GDC recognised speciality that you are registered under: (there is no extra charge for this)

	Dental and Maxillofacial
	Dental Public Health
	Endodontics
	Oral medicine
	Oral Microbiology
	Oral Pathology
	Oral surgery
	Orthodontics
	Paediatric Dentistry
	Periodontics
	Prosthodontics
	Radiology
	Restorative Dentistry
	Surgical Dentistry

PAYMENT DETAILS for Specialist promotion

SPECIAL PROMOTION RATE

COST		VAT	TOTAL
Single UK Region	£170.00	£29.75	£199.75
Each Additional Region	£79.00	£13.83	£92.83

Please add number of additional areas below.

To see the regions available please look at the map on the right.

All UK Regions:

LOOK AT THE SAVINGS FOR TOTAL UK COVERAGE INCLUDES ALL REGIONS

COST		VAT	TOTAL
ALL UK Regions	£595.00	£104.13	£699.13

Main Location:
Please choose your main area of work. You may then choose as many additional areas as you desire or even include referrals from the whole of the UK

	Scotland
	Northern England
	Midlands
	South East
	London
	South West
	Wales
	Ireland
	Northern Ireland
	Southern England

Additional Location(s):
Please check above prices and select the additional areas you desire

	All Locations
	Select Below
	Scotland
	Northern England
	Midlands
	South East
	London
	South West
	Wales
	Ireland
	Northern Ireland
	Southern England

About yourself:
Please let us have up to 120 words about yourself including the type of referrals that you wish to accept. On receipt of your application you will be given your own template to fill in all other details.

We will also offer members an "Ask the Specialist" service. Members can ask questions and receive answers on-line. If you would like to be considered as one of the Specialists featured,which includes a direct link to your own page please
tick the box and we will send you further details.

"Ask the Specialist"
For further details.

Preferred method(s) of referral:
You may choose as many as you wish

	YES	NO
Letter
Fax
Phone
Email

Would you also like to be a member of 4everlearning.com?
To see all the benefits of membership

	Specialist Application
		Membership

Once signed up as a Specialist
you will have your own detailed information page similar to the
one << shown here >>

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