Difficult Airway Society
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Online Application
STEP 1 - Online Membership Form
Note!
Click here
for details about membership types, fees and benefits
Type of Membership
Full
Associate
Select the type of membership. Full membership if medically qualified, Associate for others health professionals
Title
Enter your title.
Surname
*
Enter your Surname.
First name
*
Enter your First Name.
Email
*
Enter your email id. Please make sure you use the same email id as your PAYPAL email id, so we can track your payment.
Address Line 1
*
Enter your (most reliable) address line 1.
Address Line 2
Enter your address line 2.
Address Line 3
Enter your address line 3.
City/Town
*
Enter your city or town.
Province/county
*
Enter your State/Province/County.
Post Code
*
Enter your post code / zip code.
Country
Select country
Afghanistan
Albania
Algeria
Andorra
Angola
Antigua and Barbuda
Argentina
Armenia
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Central African Republic
Chad
Chile
China
Colombi
Comoros
Congo (Brazzaville)
Congo
Costa Rica
Cote d'Ivoire
Croatia
Cuba
Cyprus
Czech Republic
Denmark
Djibouti
Dominica
Dominican Republic
East Timor (Timor Timur)
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Fiji
Finland
France
Gabon
Gambia, The
Georgia
Germany
Ghana
Greece
Grenada
Guatemala
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
Italy
Jamaica
Japan
Jordan
Kazakhstan
Kenya
Kiribati
Korea, North
Korea, South
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mexico
Micronesia
Moldova
Monaco
Mongolia
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepa
Netherlands
New Zealand
Nicaragua
Niger
Nigeria
Norway
Oman
Pakistan
Palau
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Poland
Portugal
Qatar
Romania
Russia
Rwanda
Saint Kitts and Nevis
Saint Lucia
Saint Vincent
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia and Montenegro
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
Spain
Sri Lanka
Sudan
Suriname
Swaziland
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
Yemen
Zambia
Zimbabwe
Organisation
*
Please enter the name of the hospital/organisation where you work
Name and address of work
Please include name of instituition,phone numbers etc.,
Grade
*
Consultant, Associate specialist, ST1-7, ACCS, ODP etc.,
Professional Organisation
*
Professional Organisation you are registered with. e.g., GMC, NMC
Registration number
*
Please enter the registration number
School of anaesthesia
If your are a trainee enter your school of anaesthesia.
Supporting DAS members details
If you are applying for Associate membership, please enter supporting DAS member’s name and membership number. This information is not required if you are applying for Full membership.
Your Specialty
Anaesthesia
Intensive Care Medicine
Emergency Medicine
Other
Select your specialty
Type of Anaesthetic sub specialty
Head and Neck
Neuro surgery
Plastic Surgery
Emergency Medicine
Orthopaedic
Other
Not applicable
Select the type of membership
DAS would be grateful if you respond to the occasional DAS survey that we send you. If you would prefer NOT to receive these surveys, please tick this box.
Click here
for details of DAS surveys