Membership Application



When you complete this application form you should be aware that you must disclose all material facts. A material fact is any information that is likely to affect our decision to accept your application or the amount of subscription you pay. You are obliged to disclose this type of information to us, even if the application form has not asked specific questions about it. So, if you are unsure whether a fact is material or not, you must include it on your application form. Failure to disclose all material facts could result in your application being rejected, or you could find that your policy is invalid when you make a claim and no benefit will be payable. We will rely on what you tell us and you must not assume that we will clarify or confirm any information that you have provided with your medical attendants. Any rates, subscriptions or benefits indicated by the Society in any literature are being based on an application being accepted on normal terms. The Society reserves the right to decline membership or offer membership on different terms based on information shown on the application form or received from other sources.

Have you ever resided or have any prospect or intention of residing outside the British Isles? (please tick)

Do you intend to engage in flying other than as a fare paying passenger? (please tick)

Are you self employed? (please tick)

If employed are you on a fixed term contract?

Have you ever been refused or offered insurance on terms other than standard, for a life, accident or sickness policy?

If you have this type of cover elsewhere will it continue?

Has there been any increase or loss in your weight in the last year?

Have you ever smoked?

Have you been advised to reduce your alcohol intake?

Are you currently undergoing any treatment or awaiting any referral, tests, results or surgery?

Are you at present suffering from any disease, disorder or disability?

Have you ever taken or are you currently taking any drugs NOT prescribed by a doctor?

Have you consulted any other health professional such as a Chiropractor Osteopath?

Have you ever tested positive for HIV/Aids, Hepatitis B or C or any other sexually transmitted disease?

Have you ever had:- Anxiety, stress, depression, fatigue, breakdown or counselling?

Have you ever had:- Back, neck or shoulder pain, disc problems?

Have you ever had:- Arthritis, joint, bone, ligament or muscle problems?

Have you ever had:- Chest lung, breathing problems including asthma and bronchitis?

Have you ever had:- Heart disease, including heart attack, angina, chest pains or heart defects?

Have you ever had:- Digestive system, stomach, bowel or liver problems?

Have you ever had:- Any disorder of the genito-urinary system, kidneys, bladder or prostate?

Have you ever had:- Blood pressure problems or blood disorders?

Have you ever had:- Blood pressure problems or blood disorders?

Have you ever had:- Skin disorders or allergies?

Have you ever had:- Eye or ear problems? (You can ignore sight problems corrected by glasses or contact lenses)