Part 3

Application for individual membership

                                             Database Details

1. Area Codes (Please tick the area in which you are based)

01 Scotland [  ]      02 Republic of Ireland /N. Ireland [  ] 03 N. England [  ]

04 C. England/Midlands [  ] 05 Wales /S.W. England [  ]     06 E. Anglia [  ]

07 London /S.E. England [  ]                      8 Overseas [  ]

2. Research Interests

For each of the following please tick box A if you have participated in research in this area and are willing to network to provide support to others, or tick box B if this is an area of interest to you but you have little or no research experience.

	A	B		A	B
Adult Grief	.	.	Children's Grief	.	.
HIV/AIDS & Bereavement	.	.	Suicide	.	.
PTSD	.	.	Loss of Child	.	.
Evaluation	.	.	Qualitative Research	.	.
Instrument Development	.	.	Outcome Measures	.	.
Ethics	.	.	Risk Assessment	.	.
Interventions	.	.	Involvement of Volunteers	.	.
Involvement of Profs	.	.	Other	.	.
Pregnancy Loss	.	.

3. Declaration

I have read the BRF Data protection Statement,(attached) and I agree for my details to be kept on the BRF database and for data to be used as described.