GPSA Website Please Update My Membership Details

Member Details

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* 1. Please enter your details in the boxes below:

Name

Mobile Phone number

Old Email Address

New Email Address

New Organisational Name

New Work Address

PO Box address

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* 2. Membership Type

Ordinary Member - Supervisor

Ordinary Member - Practice Manager

Honorary

Stakeholder

Unsure

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* 3. Other Comments

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* 4. Changes to be effective from

Date

Date