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Please take a few moments to complete this 'Proposal form'. We will contact you as soon as possible. Please note that SHASTD members must be working as Health Advisers in a UK or Ireland GUM clinic. It is also required that they join the MSF trade union.  Our membership Secretary is Dilip Lakhani. Contact him at Dilip.Lakhani@gstt.sthames.nhs.uk for further information.

Full name
Proposed by
Seconded by
Home Address
Telephone number
Work Address
Work telephone number
Job title
Date started
Salary scale
Previous relevant work experience
Any comments or question
Your e-mail address

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           postal address:MSF Centre, 33-37 Moreland Street, London, EC1V 8BB.                      

  electronic mail: lynnwil69@hotmail.com

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