rev 13.04.18 Revalidation PART A: to be completed by the Revalidation Applicant, accompanied by log book. Title (Dr, Mr, Mrs, Ms etc.) First name Surname Job Place of Work Correspondence address To your new certificate will be mailed including postcode Mobile telephone number Email address The date on your original Certificate of STIF Advanced Competency Name of Original STIF Advanced Competency Trainer (as shown on your Certificate of Competency) Name of Registered STIF Competency Trainer signing off your revalidation application Are you a current paid-up member of BASHH? [ ] Yes Revalidation is free. Please give your username below. BASHH username: [ ] No Please pay the full registration fee of = £60 £50+VAT Please enclose a cheque for £60 made payable to BASHH or email to arrange payment by BACS or PayPal 1. Clinical experience In order to maintain skills, Revalidation Applicants should be seeing a minimum of 15 patients/ year with sexual health related problems during the course of their clinical practice. You do not have to submit your evidence with this form, but reserves the right to request this
rev 13.04.18 Revalidation PART A: to be completed by the Revalidation Applicant, accompanied by log book. Title (Dr, Mr, Mrs, Ms etc.) First name Surname Job Place of Work Correspondence address To your new certificate will be mailed including postcode Mobile telephone number Email address The date on your original Certificate of STIF Advanced Competency Name of Original STIF Advanced Competency Trainer (as shown on your Certificate of Competency) Name of Registered STIF Competency Trainer signing off your revalidation application Are you a current paid-up member of BASHH? [ ] Yes Revalidation is free. Please give your username below. BASHH username: [ ] No Please pay the full registration fee of £50+VAT = £60 Please enclose a cheque for £60 made payable to BASHH or email to arrange payment by BACS or PayPal 1. Clinical experience In order to maintain skills, Revalidation Applicants should be seeing a minimum of 15 patients/ year with sexual health related problems during the course of their clinical practice. You do not have to submit your evidence with this form, but reserves the right to request this