Join the PCCS

To Join the PCCS, please enter your details below and press 'Submit'. Fields marked with a '*' are compulsory

Your Details  
Name*
Work Address:  
Building name/Number*
 
Town/City*
County*
Post Code*
Mailing Address: (If different)  
Building name/Number
 
Town/City
County
Post Code
Email Address*
Telephone Number*
Fax Number
Date of Birth* (mm/dd/yyyy)
Sex*



Interests and Qualifications  
Qualifications*
Particular Cardiovascular Interests*

Secondary Prevention
Primary Prevention
Hyperlipideamia
Hypertension
Heart Failure
Chest Pain
Unstable Angina
Atrial Fibrillation
Diabetes
Other (Please specify below)

Other (give details)
Current Involvement in Cardiology (E.g. Tutor, clinical assistan, guidelines committee, PGEA programme etc.)*
Have you undertaken cardiovascular research?*


Brief Details
Have you published research papers/articles in GP press on cardiovascular disease?*
Brief Details
Your Preferences  
Are you willing to speak on cardiovascular disease?*


Preferred Audience
Please indicate which subgroup/forum of the PCCS you would like to join*

GP with Specialist Interest in Cardiology (GPwSI)
Cardiovascular Nurse Leaders (CVNL)
Anti coagulation working party
None of these

I am happy for the details I have provided to be held on the PCCS database with the understanding that no data will be released without the permission of the steering group.*