Asylum seeker and refugee membership
Application form

*

Please confirm your name

Required - Required.

This question requires an answer

Forename(s)

Surname:

*

Date of birth:

Required - Required.

DD/MM/YYYY

*

UK mailing address:

Required - Required.

This question requires an answer

House/Flat number:

Address line:

Town/city:

Country:

Postcode:

*

Email address:

Required - Required.

*

Mobile number:

Required - Required.

*

Are you working towards GDC registration? 

Required - Required.

Yes

No

Other (please specify):

This is required

Input box for - Other (please specify):

*

What's your status:

Required - Required.

Refugee

Asylum seeker

Temporary refugee permission/humanitarian protection

*

Please attach a copy of your original dental qualification

Required - Required.

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One file allowed, up to 10 MB

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*

Please attach evidence of your Asylum Seeker or Refugee status, including your ILR (Indefinite leave to remain):

Required - Required.

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Please upload a letter of good standing from your home dental association (if available):

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Relevant additional information: