Member Registration
Please complete the form below to register online as an ISQSH member.
All fields marked with an asterisk (
*
) are required.
Account Details
Email Address
*
Newsletter
Method of Payment
*
Cheque
Credit Card
Invoice
Personal Details
Title
*
---
Mr
Mrs
Ms
Miss
Dr
Fr
Sr
Professor
First Name
*
Last Name
*
Contact Address
*
Country of Residence
*
----------
Ireland
England
Scotland
Wales
Germany
France
Holland
Australia
Phone Number(s)
(home)
(work)
(mobile)
Organisation
Job Title
Billing Details
Same as above
Title
*
---
First Name
*
Last Name
*
Contact Address
*
Country of Residence
*
-- please select one --
Phone Number(s)
(home)
(work)
(mobile)
Organisation
Job Title
Professional Discipline
Medical
Nursing
Paramedical
Quality/Risk Management
General Management
Other (please specify)
Health Sector
Acute Care
Primary Care
Elderly Care
Mental Health
Child Health/Care
Disabilities
Central Management
Other (please specify)
Interests
Evidence Based Care
Quaility Framework/Tools
Risk Management
Patient Safety
Training/Education
Project Management
Change Management
Information Technology
Research
Clinical Audit
Team Work
Leadership
Strategic Planning
Communication
Other (please specify)
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