Application for membership - state indemnified consultants and hospital doctors

In the Republic of Ireland

Please complete the following to apply for membership.

This membership is for doctors who don't do any private clinical work. It doesn't include indemnity for clinical negligence claims. It includes indemnity for certain fee-paying non-clinical work, providing you will not earn more than €1,500 gross each year. For more details of this work, refer to the member guide.

As an organisation, we understand that data must be handled securely. For more information about how we collect, store and use data please see our privacy policy at themdu.com/privacy. We may use your data to contact you about the application, including incomplete applications.

Are you a current member of the MDU? *This question is required.

Please call our membership team on 1800 509 132 between 8am and 6pm, Monday to Friday to discuss your working circumstances further.

Your details

Former MDU number (if applicable)

Title *This question is required.

Forenames *This question is required.

Surname *This question is required.

Date of birth (dd/mm/yyyy) *This question is required. This question requires a valid date format of DD/MM/YYYY.

calendar

IMC registration number *This question is required. This question requires a valid number format.

Correspondence address line 1 *This question is required.

Correspondence address line 2 *This question is required.

Correspondence address line 3 *This question is required.

Correspondence address line 4

Email address *This question is required. This question requires a valid email address.

Mobile telephone number (including country code) *This question is required. This question requires a valid number format.

MDU Services Limited (MDUSL) is authorised and regulated by the Financial Conduct Authority for insurance mediation and consumer credit activities only. MDUSL is an agent for The Medical Defence Union Limited (MDU). MDU is not an insurance company. The benefits of MDU membership are all discretionary and are subject to the Memorandum and Articles of Association. MDU Services Limited, registered in England 3957086. Registered Office: One Canada Square, London E14 5GS