PROCESS All parts of this application form must be completed. Please ensure it is duly signed by the applicant and the nominator and Board Member. Together with the applicant’s current CV, it should be sent or Jane Donald. Faculty of Dental Surgery, The Royal College of Surgeons of England, 35-45 Lincoln’s Inn Fields, London, WC2A 3PE, United Kingdom. (.) 2. Once the form is received at the Faculty, the nomination will be put forward to the Fellowship & Awards Committee and, if the Membership is supported, it will be agreed by the Executive Committee and ratified at a subsequent Board meeting. 3. The ad eundem nominee will be notified by the Dean’s office when the process is complete and will be invited to one of the Faculty’s Diplomates’ ceremonies to receive their award. APPLICATION FOR Membership ad eundem PART A: To be completed by the Applicant SECTION 1 Applicant - Personal Details – Title: First Names: Last Name: Gender Male Female SECTION 2 Contact Details – HOME WORK Address Address Postcode/Zip code Postcode/Zip code Country: Country: Email: Email: Preferred place of Home Work contact: SECTION 3 - Qualifications Primary qualification: Date Awarded Name of awarding institution/College: Country: Higher qualifications (please list) Date:
PROCESS All parts of this application form must be completed. Please ensure it is duly signed by the applicant and the nominator and Board Member. Together with the applicant’s current CV, it should be sent or Jane Donald. Faculty of Dental Surgery, The Royal College of Surgeons of England, 35-45 Lincoln’s Inn Fields, London, WC2A 3PE, United Kingdom. (.) 2. Once the form is received at the Faculty, the nomination will be put forward to the Fellowship & Awards Committee and, if the Membership is supported, it will be agreed by the Executive Committee and ratified at a subsequent Board meeting. 3. The ad eundem nominee will be notified by the Dean’s office when the process is complete and will be invited to one of the Faculty’s Diplomates’ ceremonies to receive their award. APPLICATION FOR Membership ad eundem PART A: To be completed by the Applicant SECTION 1 – Applicant - Personal Details Title: First Names: Last Name: Gender Male Female SECTION 2 – Contact Details HOME WORK Address Address Postcode/Zip code Postcode/Zip code Country: Country: Email: Email: Preferred place of contact: Home Work SECTION 3 - Qualifications Primary qualification: Date Awarded Name of awarding institution/College: Country: Higher qualifications (please list) Date:
dental-mem-ad-eu.docx