ACA Members Area

Membership Type *	Full Member (UK) (£45.00) Open to individuals who are qualified health or allied care professionals and to others at the discretion of the Executive Committee Associate Member (UK) (£35.00) Open to those individuals who do not hold recognised professional health or allied care qualifications, but who work in paid employment in continence promotion and care and who wish to support the work of the Charity: and students working towards a recognised health or allied care qualification Group Member (UK) (£68.09) Available through nominated representatives to Statutory Authorities, Nursing Homes and Voluntary Organisations (please note VAT at 17.5% is applicable to this membership - price shown is exclusive of VAT) Full Member (Overseas) (£60.00) Open to overseas individuals who are qualified health or allied care professionals and to others at the discretion of the Executive Committee Associate Member (Overseas) (£50.00) Open to overseas individuals who do not hold recognised professional health or allied care qualifications, but who work in paid employment in continence promotion and care and who wish to support the work of the Charity: and students working towards a recognised health or allied care qualification Group Member (Overseas) (£102.13) Available through nominated representatives to Statutory Authorities, Nursing Homes and Voluntary Organisations in non UK countries (please note VAT at 17.5% is applicable to this membership - price shown is exclusive of VAT) Retired Member (£25.00) Offered to those individuals who are retired members of the Charity Corporate Member (UK) (£450.00) (please note VAT at 17.5% is applicable to this membership - price shown is exclusive of VAT) Corporate Member (Overseas) (£650.00) (please note VAT at 17.5% is applicable to this membership - price shown is exclusive of VAT)
Payment System *	WorldPay (NOT ACTIVE CURRENTLY) Pay by credit card/debit card - Visa/Mastercard/Eurocard/Delta/Solo/Switch/JCB Pay by telephone / cheque / bank transfer / invoice (Online payment options coming soon)
Your Name * Your First & Last name
Your E-Mail Address * A confirmation email will be sent to you at this address
Choose a Login Name (User ID) * It must be 4 or more characters in length and may only contain small letters, numbers, and the underscore '_'	check for uniqueness
Choose a Password * Must be 4 or more characters
Confirm your password * Enter password again
Title (Mr/Mrs/Miss/Dr/Ms)
Job Title
Name of Employer
Department
Hospital/Company
Address 1
Address 2
Town / City
County / State
Country
Post Code
Contact Telephone
(Ext) Telephone extension is applicable.
Fax
Mobile (optional)
Home Telephone (optional)
Choose Branch *
INFORMATION ON SPECIALITIES In order to provide demographic information on the range of membership, the ACA would be interested in knowing the general category of member from the list below and areas of work. (Hold down Ctrl on your keyboard to select more than one option).
Other (Please Specify)
Professional Qualifications eg Continence Advisor, RGN, SEN (Gen), Dip Nursing
Academic Qualifications eg BSc/BA, Masters Degree, Doctorate, Other
Mailing Address 1 Address to send correspondence to (if different)
Mailing Address 2
Mailing Address 3
Mailing Town/City
Mail County
Mail Postcode
Mail Zone
Invoice Address 1 Address for invoice to be sent to (if paying by invoice).
Invoice Address 2
Invoice Address 3
Invoice Address 4
Invoice Town/City
Invoice Postcode
Invoice Country
Professional Body's Reg. Number * eg. Nursing Registration Number, CSP etc
Prof Reg No: Expiry Date
Specialist Groups Specialist interest groups you would be interested in joining. (Hold down Ctrl on your keyboard to select more than one option).
Other Associations Are you a member of any other associations?
Contact By 3rd Parties Would you like to be contacted by selected 3rd parties about relevant products, or services?	Yes
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Full Member (Overseas) (£60.00)
Open to overseas individuals who are qualified health or allied care professionals and to others at the discretion of the Executive Committee

Associate Member (Overseas) (£50.00)
Open to overseas individuals who do not hold recognised professional health or allied care qualifications, but who work in paid employment in continence promotion and care and who wish to support the work of the Charity: and students working towards a recognised health or allied care qualification

Group Member (Overseas) (£102.13)
Available through nominated representatives to Statutory Authorities, Nursing Homes and Voluntary Organisations in non UK countries (please note VAT at 17.5% is applicable to this membership - price shown is exclusive of VAT)

Retired Member (£25.00)
Offered to those individuals who are retired members of the Charity

Corporate Member (UK) (£450.00)
(please note VAT at 17.5% is applicable to this membership - price shown is exclusive of VAT)

Corporate Member (Overseas) (£650.00)
(please note VAT at 17.5% is applicable to this membership - price shown is exclusive of VAT)

Please choose...
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***Speciality****
Doctor
Education Professional
Health Care Assistant
Health Visitor
Midwife
Nurse
Occupational Therapist
Physiotherapist
School Nurse
Social Worker
Student
Other Speciality...
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***Area of Work****
Bladder
Bowel Care/Dysfunction
Catheters
Continence
Continence - Adult
Continence - Children
Continence - Female
Continence - Male
Continence Advisor
Continence Link Nurse
Cystoscopy
Education
Geriatrics
Incontinence
NHS
NHS - Outpatients
NHS- Inpatients
Nurse Prescribing
Nursery/Schools
Nursing Homes
Obstestrics
Paediatrics
Pelvic Floor Care
Private - Inpatients
Private - Outpatients
Private Practice
Residential Home
Toilet Training
Urodynamics
Urogynaecology
Urology
Women's Health
Other Work Area...

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