Membership Type * Full (£100) Full (Scotland - £50) Individual (£75) Corporate (£400) About your Organisation Organisation Name * Street Address * Street Address Line 2 Street Address Line 3 City * Country * GuernseyIrelandIsle of ManJerseyUnited Arab EmiratesUnited Kingdom State/Province * Postal Code * Phone Number * Email * Software type Number of patients under 1000 1,000 - 4,999 5,000 - 10,000 Over 10,000 Number of doctors EMIS Installation number (CDB number) * If you do not have a CDB number because you are in the process of transferring to EMIS, please insert "not applicable" and a member of the office will contact you. About You First Name * Last Name * Email * What best describes you? * Doctor Practice Nurse Practice Manager IT Community nurse Administrator / Reception Other Give the value of EMIS NUG membership to everyone Each person who works in your organisation can access the benefits of EMIS NUG membership individually. We need the email address for each person you wish to add so that we can send an invitation for them to log into the website once your membership is accepted. Please add as many emails as you can. Please note EMIS NUG shares your CDB/site number with EMIS and our external event company but no other data is shared with any other third party. Email Email Email Email Email Email CAPTCHAThis question is for testing whether or not you are a human visitor and to prevent automated spam submissions. Math question * 2 + 16 = Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.