Affiliate Member Registration

To apply for membership please complete and submit this form. After submission you may choose to pay by invoice or credit card.

If you are an agency/consultancy you will be required to upload references on the next page - please check now to ensure that you have the correct details to hand. (the References page of the form will become visible when you select 'Agency' from the drop-down box for Organisation Type).

Please enter the information for your organisation below.

Please enter the information for the BHIBA member you are affiliated to.

Membership Type

Membership Number of BHBIA member affiliated to:

If you don't know the Membership number of the BHBIA member you are affiliated to please enter its company name instead.

Membership Name of BHBIA member affiliated to:

Please enter the information for your organisation below.

Organisation Type:*

Organisation Name:*

Address 1:*

Address 2:

Address 3:

Town / City:*

Postcode:*

County/State:

State:*

Country:*

Telephone (Switchboard):*

Fax:*

Website:*

New Logo/image (JPG, PNG, GIF):

Display company name and website address in public area of the BHBIA website?

Display full member organisation details in members area of the BHBIA website?

* Denotes mandatory field

Thank you for completing Step 1.

To continue with your membership application please complete and submit the form below.

A reference must be supplied from a referee in the division of your organisation that is an existing BHBIA member company. Please note that the reference - in the form of a letter or copy email to be uploaded below - must include your eligibility for affiliate membership (i.e. verify that your primary business purpose is to supply business intelligence services).

You will also need to provide your agency's areas of expertise, which will be displayed in the Members Directory.

Click here to view the BHBIA Privacy Notice

Reference

Contact Name: *

Job Title:*

Company Name:*

Address 1:*

Address 2:

Address 3:

Town / City:*

Postcode:*

Email:*

Notes:

Reference Letter (PDF, DOC, DOCX):*

Business Intelligence Experience / Areas of Expertise: *

Key Areas:*You can select a max of 5 key areas

General:*You can select as many general
areas of expertise as are required.

* Denotes mandatory field

Thank you for completing Step 2.

To continue with your membership application please complete and submit the form below.

Please enter details of the person who will be the Main Contact for your organisation and will appear in your company's online listing (unless they opt out of this). They must take responsibility for colleagues' adherence to the BHBIA Guidelines and membership conditions (see 'Payment and Terms' section of this form).

We strongly recommend that Main Contacts select the 'Email and Hard copy' or 'Email' option under mailing preferences, to ensure that you do not miss any important communications (Certain communications are sent only to key contacts so that they can co-ordinate their company's response).

The Main Contact can also update your company's listing online and amend details of individuals within the company.

Click here to view the BHBIA Privacy Notice

Email Address:*

Confirm Email Address:*

Password:*

Confirm Password:*

Forename:*

Surname:*

Job Title:*

Telephone (Direct Line):

Display main contact details in members area of the BHBIA website.

Mailing Preferences:*

Mailing Areas Of Interest

* Denotes mandatory field

Thank you for completing Step 3.

To continue with your application please complete and submit the form below.

Please enter details of the person who will be the 'Administrator' for your organisation.

The Administrator is responsible for updating your company's listing online and can also amend details of individuals within the company.

We strongly recommend that Administrators select the 'Email and Hard copy' or 'Email' option under mailing preferences, to ensure that you do not miss any important communications. (Certain communications are sent only to key contacts so that they can co-ordinate their company's response).

Click here to view the BHBIA Privacy Notice

Email Address:*

Confirm Email Address:*

Password:*

Confirm Password:*

Forename:*

Surname:*

Job Title:*

Telephone (Direct Line):

Display administrator details in members area of the BHBIA website.

Mailing Preferences:*

Mailing Areas Of Interest

* Denotes mandatory field

Thank you for completing Step 4.

To continue with your membership application please complete and submit the form below.

Please submit the details of the person who is completing this form on behalf of the Main Contact.

We will contact you with any queries.

Click here to view the BHBIA Privacy Notice

Forename:*

Surname:*

Job Title:*

Email Address:*

Confirm Email Address:*

* Denotes mandatory field

Thank for completing Step 5.

To complete your membership application please complete and submit the form below.

Please note that these declarations are to be made on behalf of your company's Main Contact. They are the person who is required to ensure that all employees adhere to the BHBIA Guidelines and membership conditions.

Please note that your membership will not be activated until payment has been received and your application has been approved by the Membership Committee, which may take up to 2 weeks.

Payment Method:*I would like to be invoicedI would like to pay onlineI would like a quote

Purchase Order Number:*

I have read and accepted the Terms of Payment

I agree that the Main Contact for my organisation has read and agree to abide by the BHBIA Legal & Ethical Guidelines for Healthcare Market Research and the BHBIA/ABPI Adverse Event Reporting guidance when carrying out business intelligence within the UK. I understand that the Main Contact is also responsible for colleagues’ adherence to these guidelines.

I understand that all employees of my organisation will be able to access the BHBIA’s online training for both Legal & Ethical Guidelines and Adverse Event Reporting, and that when they take the competency tests and become certified this will be displayed in the online Member Directory (if they have opted to be listed in the directory) and on delegate lists for events, unless they choose to opt out. (We advise main contacts to recommend that all staff involved in market research obtain certification in both areas).

I understand that membership does not include colleagues from other offices within the organisation that are not part of the same legal entity or at the same address. Other offices must apply for separate affiliate membership in order to access BHBIA member benefits.

* Denotes mandatory field

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