Provisional Membership Application : BAGIS

Please check that you are applying for the right category of membership.

Provisional membership is for people who work clinically with gender diverse people but where their experience, skills and knowledge is in development. This would apply to a trainee practitioner or a qualified practitioner in a relevant discipline who wishes to train in the field.

Application Form

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NOTE: If you experience any difficulties submitting the form please contact the Secretary who will endeavour to find a solution.

Do you presently have a base of work located in the British Isles (Great Britain, Ireland, Isle of Man, Orkney, Shetland or the Channel Isles, part of Great Britain)?*
- Yes
- No
If the answer is NO then we are unable to accept your application.
First Name*
Last Name*
Username*
Password
Enter Password Confirm Password
Job Title*
Please select the professional you PRIMARILY work in*
- Mental Health Nurse
- Surgical/General Nurse
- Counselling Psychologist/Clinical Psychologist
- Psychotherapist/Counsellor/Psychosexual Therapist
- Speech & Language Therapist
- Medical Endocrinologist
- Medical Practitioner Psychiatrist/GP/Other
- Surgical (Chest/Genital Feminising/Genital Masculinising)
- Occupational Therapist
Street Address*

Please note this should be your professional address (not home address)
Apartment, suite, etc
Town/City
County
Postal Code
Country
Email Address*
Relevant qualification(s) and/or training*
Workplace - please describe the setting you work in*
When was your last professional appraisal review e.g. appraisal, JDR?*
MM slash DD slash YYYY
Name of regulatory body or register accredited by the Professional Standards Authority (PSA) (e.g. GMC, HCPC, NMC, UKCP, ACP (Association of Child Psychotherapists), Social Work England).
Your Accountable Body Number.
If you are unable to supply this information you cannot proceed but please contact the secretary if necessary to discuss.
Professional Registration(s) as applicable.
Please also provide the registration number(s) as applicable:
How many months or years have you worked within the field of gender dysphoria (to the nearest year)?*
Please describe your current clinical practice in gender dysphoria*
Please describe your supervision arrangements and experience of multidisciplinary working e.g. formal clinical supervision, peer supervision, MDT meetings:*
Have you achieved 17 hours of gender-related CPD in the last 12 months?*
- Yes
- No
If NO we will need to contact you to learn more. Please tell us your preferred contact details and if there are particular days or times that are best to reach you.
Please describe your relevant experience in gender dysphoria*
Please describe any research experience and current projects (if relevant)
Please list any relevant publications (if applicable)
Please give contact details for two referees. One must be a full member of BAGIS and one must be able to comment on your day-to-day practice but need not be a member of BAGIS. You should ask their permission as they are likely to be contacted as part of your application. Please include names, job titles, addresses, telephone numbers and email addresses as well as duration of professional relationship*
Are you currently subject to any disciplinary measures?*
- Yes
- No
Are you currently subject to fitness to practice proceedings?*
- Yes
- No
Has your organisation been refused CQC/HIW/CI/HIS/RQIA/HIQA approval since your last application?*
- Yes
- No
- Not Relevant
Have you ever been removed from a professional register?*
- Yes
- No
- Not Relevant
Have you ever been refused membership of an accountable or regulatory body?*
- Yes
- No
- Not Applicable
Have you ever been suspended?*
- Yes
- No
Have you ever been the subject of a criminal investigation or been convicted of an offence (that would affect your ability to practice)?*
- Yes
- No
If you answered YES to any of the above questions, we will need to contact you to learn more. Please provide your preferred contact details and if there are particular days or times that are best to reach you.
I declare that the information provided in this application is accurate and correct to the best of my knowledge. I agree to uphold the values of the organisation and adhere to the constitution, maintain annual performance reviews, as appropriate to my discipline and regulatory body (if applicable), to report any changes to my professional registration and report any and all suspensions, disciplinary measures and/or fitness to practice proceedings to BAGIS immediately. I understand that if I do not comply with these requirements, my membership of BAGIS may be suspended and ultimately withdrawn.*
- I agree
GDPR*
I confirm that I have read and agree with the Data Protection Policy on the BAGIS website
Electronic signature below please*
Date*
YYYY dash MM dash DD
Provisional Membership Application
Price:
Total
£ 0.00
Credit Card
Card Details
Cardholder Name