Page 1 of 3 BASW are delighted to provide group student memberships with select universities across the UK. If you are an existing BASW member please contact our membership team directly on 0121 622 8401, please do not complete this form. This form is provided in conjunction with group student memberships. Should you be joining as an individual student, please use this joining form. Your details Title * - Select -MsMrMrsMissMxDrProfSirRevLordLadyDameCaptainBrotherSisterDeaconProfessorRt Hon First name * Last name * Birth date * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year19241925192619271928192919301931193219331934193519361937193819391940194119421943194419451946194719481949195019511952195319541955195619571958195919601961196219631964196519661967196819691970197119721973197419751976197719781979198019811982198319841985198619871988198919901991199219931994199519961997199819992000200120022003200420052006200720082009201020112012201320142015201620172018201920202021202220232024 Your main contact details Phone number * Please enter mobile numbers preceded by + country code, no preceding 0 and no gaps e.g. +441234567890 (+44 for UK) Phone type * - Select -LandlineMobile Email address * Postal code * Enter your postcode to find your address (leaving a 1 character space between the first and second parts of the postcode) Street address * Address line 2 Address line 3 Town/ City * County Qualifications / Courses Qualification * - Select -BA (Hons)BSc (Hons)BSWCQSWMNSWMAMScMSWPG DipPhDOther (Please State) Other Qualification * Course title * - Select -Adult Nursing and Social WorkApplied Social WorkChildren's Nursing and Social WorkIntegrated Practice in Learning Disabilities, Nursing and Social WorkLearning Disabilities, Nursing and Social WorkMental Health Nursing and Social WorkNursing (Learning Disability) and Professional Social Work PracticeSocial WorkSocial Work and Applied Social StudiesSocial Work (Children and Families)Social Work PracticeSocial Work (Step up to Social Work)Social Work StudiesSocial Work with Honours in Social Work, Ethics and ReligionStep up to Social WorkOther (Please State) Other course title * University or institution * - Select -Kingston UniversityBuckinghamshire New UniversityNottingham Trent University Other university or institution * Programme (if applicable) - None -Step up to Social WorkThink AheadFront Line Expected date of qualification * Day Day12345678910111213141516171819202122232425262728293031 Month MonthJanFebMarAprMayJunJulAugSepOctNovDec Year Year202420252026202720282029203020312032203320342035203620372038203920402041204220432044204520462047204820492050205120522053205420552056205720582059206020612062206320642065206620672068206920702071207220732074 University or institution Student ID * Regulator registration information Are you a registered with your relevant regulator? * - Select -YesNo Regulatory body * - Select -NISCCSCWSSSCSWE Regulatory body no. * Leave this field blank