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value="" required /></li><li class="wppb-form-field wppb_billing_last_name"> <label for="billing_last_name">Last Name<span class="wppb-required" title="This field is required">*</span></label> <input class="extra_field_input" name="billing_last_name" type="text" id="billing_last_name" value="" required /></li><li class="wppb-form-field wppb_billing_company"> <label for="billing_company">Company Name</label> <input class="extra_field_input" name="billing_company" type="text" id="billing_company" value="" /></li><li class="wppb-form-field wppb_billing_address_1"> <label for="billing_address_1">Address<span class="wppb-required" title="This field is required">*</span></label> <input class="extra_field_input" name="billing_address_1" type="text" id="billing_address_1" value="" required /></li><li class="wppb-form-field wppb_billing_address_2"> <label for="billing_address_2"></label> <input class="extra_field_input" name="billing_address_2" type="text" id="billing_address_2" value="" /></li><li class="wppb-form-field wppb_billing_city"> <label for="billing_city">Town / City<span class="wppb-required" title="This field is required">*</span></label> <input class="extra_field_input" name="billing_city" type="text" id="billing_city" value="" required /></li><li class="wppb-form-field wppb_billing_state"> <label for="billing_state">County</label><input class="extra_field_input" name="billing_state" type="text" id="billing_state" value="" /> </li><li class="wppb-form-field wppb_billing_country"> <label for="billing_country">Country<span class="wppb-required" title="This field is required">*</span></label> <select name="billing_country" id="billing_country" class="country_to_state custom_field_country_select"><option value="" selected >Select an option…</option><option value="AF">Afghanistan</option><option value="AX">Åland Islands</option><option value="AL">Albania</option><option value="DZ">Algeria</option><option value="AS">American Samoa</option><option value="AD">Andorra</option><option value="AO">Angola</option><option value="AI">Anguilla</option><option value="AQ">Antarctica</option><option value="AG">Antigua and Barbuda</option><option value="AR">Argentina</option><option value="AM">Armenia</option><option value="AW">Aruba</option><option value="AU">Australia</option><option value="AT">Austria</option><option value="AZ">Azerbaijan</option><option value="BS">Bahamas</option><option value="BH">Bahrain</option><option value="BD">Bangladesh</option><option value="BB">Barbados</option><option value="BY">Belarus</option><option value="PW">Belau</option><option value="BE">Belgium</option><option value="BZ">Belize</option><option value="BJ">Benin</option><option value="BM">Bermuda</option><option value="BT">Bhutan</option><option value="BO">Bolivia</option><option value="BQ">Bonaire, Saint Eustatius and Saba</option><option value="BA">Bosnia and Herzegovina</option><option value="BW">Botswana</option><option value="BV">Bouvet Island</option><option value="BR">Brazil</option><option value="IO">British Indian Ocean Territory</option><option value="BN">Brunei</option><option value="BG">Bulgaria</option><option value="BF">Burkina Faso</option><option value="BI">Burundi</option><option value="KH">Cambodia</option><option value="CM">Cameroon</option><option value="CA">Canada</option><option value="CV">Cape Verde</option><option value="KY">Cayman Islands</option><option value="CF">Central African Republic</option><option value="TD">Chad</option><option value="CL">Chile</option><option value="CN">China</option><option value="CX">Christmas Island</option><option value="CC">Cocos (Keeling) Islands</option><option value="CO">Colombia</option><option value="KM">Comoros</option><option value="CG">Congo (Brazzaville)</option><option value="CD">Congo (Kinshasa)</option><option value="CK">Cook Islands</option><option value="CR">Costa Rica</option><option value="HR">Croatia</option><option value="CU">Cuba</option><option value="CW">Curaçao</option><option value="CY">Cyprus</option><option value="CZ">Czech Republic</option><option value="DK">Denmark</option><option value="DJ">Djibouti</option><option value="DM">Dominica</option><option value="DO">Dominican Republic</option><option value="EC">Ecuador</option><option value="EG">Egypt</option><option value="SV">El Salvador</option><option value="GQ">Equatorial Guinea</option><option value="ER">Eritrea</option><option value="EE">Estonia</option><option value="SZ">Eswatini</option><option value="ET">Ethiopia</option><option value="FK">Falkland Islands</option><option value="FO">Faroe Islands</option><option value="FJ">Fiji</option><option value="FI">Finland</option><option value="FR">France</option><option value="GF">French Guiana</option><option value="PF">French Polynesia</option><option value="TF">French Southern Territories</option><option value="GA">Gabon</option><option value="GM">Gambia</option><option value="GE">Georgia</option><option value="DE">Germany</option><option value="GH">Ghana</option><option value="GI">Gibraltar</option><option value="GR">Greece</option><option value="GL">Greenland</option><option value="GD">Grenada</option><option value="GP">Guadeloupe</option><option value="GU">Guam</option><option value="GT">Guatemala</option><option value="GG">Guernsey</option><option value="GN">Guinea</option><option value="GW">Guinea-Bissau</option><option value="GY">Guyana</option><option value="HT">Haiti</option><option value="HM">Heard Island and McDonald Islands</option><option value="HN">Honduras</option><option value="HK">Hong Kong</option><option value="HU">Hungary</option><option value="IS">Iceland</option><option value="IN">India</option><option value="ID">Indonesia</option><option value="IR">Iran</option><option value="IQ">Iraq</option><option value="IE">Ireland</option><option value="IM">Isle of Man</option><option value="IL">Israel</option><option value="IT">Italy</option><option value="CI">Ivory Coast</option><option value="JM">Jamaica</option><option value="JP">Japan</option><option value="JE">Jersey</option><option value="JO">Jordan</option><option value="KZ">Kazakhstan</option><option value="KE">Kenya</option><option value="KI">Kiribati</option><option value="KW">Kuwait</option><option value="KG">Kyrgyzstan</option><option value="LA">Laos</option><option value="LV">Latvia</option><option value="LB">Lebanon</option><option value="LS">Lesotho</option><option value="LR">Liberia</option><option value="LY">Libya</option><option value="LI">Liechtenstein</option><option value="LT">Lithuania</option><option value="LU">Luxembourg</option><option value="MO">Macao</option><option value="MG">Madagascar</option><option value="MW">Malawi</option><option value="MY">Malaysia</option><option value="MV">Maldives</option><option value="ML">Mali</option><option value="MT">Malta</option><option value="MH">Marshall Islands</option><option value="MQ">Martinique</option><option value="MR">Mauritania</option><option value="MU">Mauritius</option><option value="YT">Mayotte</option><option value="MX">Mexico</option><option value="FM">Micronesia</option><option value="MD">Moldova</option><option value="MC">Monaco</option><option value="MN">Mongolia</option><option value="ME">Montenegro</option><option value="MS">Montserrat</option><option value="MA">Morocco</option><option value="MZ">Mozambique</option><option value="MM">Myanmar</option><option value="NA">Namibia</option><option value="NR">Nauru</option><option value="NP">Nepal</option><option value="NL">Netherlands</option><option value="NC">New Caledonia</option><option value="NZ">New Zealand</option><option value="NI">Nicaragua</option><option value="NE">Niger</option><option value="NG">Nigeria</option><option value="NU">Niue</option><option value="NF">Norfolk Island</option><option value="KP">North Korea</option><option value="MK">North Macedonia</option><option value="MP">Northern Mariana Islands</option><option value="NO">Norway</option><option value="OM">Oman</option><option value="PK">Pakistan</option><option value="PS">Palestinian Territory</option><option value="PA">Panama</option><option value="PG">Papua New Guinea</option><option value="PY">Paraguay</option><option value="PE">Peru</option><option value="PH">Philippines</option><option value="PN">Pitcairn</option><option value="PL">Poland</option><option value="PT">Portugal</option><option value="PR">Puerto Rico</option><option value="QA">Qatar</option><option value="RE">Reunion</option><option value="RO">Romania</option><option value="RU">Russia</option><option value="RW">Rwanda</option><option value="ST">São Tomé and Príncipe</option><option value="BL">Saint Barthélemy</option><option value="SH">Saint Helena</option><option value="KN">Saint Kitts and Nevis</option><option value="LC">Saint Lucia</option><option value="SX">Saint Martin (Dutch part)</option><option value="MF">Saint Martin (French part)</option><option value="PM">Saint Pierre and Miquelon</option><option value="VC">Saint Vincent and the Grenadines</option><option value="WS">Samoa</option><option value="SM">San Marino</option><option value="SA">Saudi Arabia</option><option value="SN">Senegal</option><option value="RS">Serbia</option><option value="SC">Seychelles</option><option value="SL">Sierra Leone</option><option value="SG">Singapore</option><option value="SK">Slovakia</option><option value="SI">Slovenia</option><option value="SB">Solomon Islands</option><option value="SO">Somalia</option><option value="ZA">South Africa</option><option value="GS">South Georgia/Sandwich Islands</option><option value="KR">South Korea</option><option value="SS">South Sudan</option><option value="ES">Spain</option><option value="LK">Sri Lanka</option><option value="SD">Sudan</option><option value="SR">Suriname</option><option value="SJ">Svalbard and Jan Mayen</option><option value="SE">Sweden</option><option value="CH">Switzerland</option><option value="SY">Syria</option><option value="TW">Taiwan</option><option value="TJ">Tajikistan</option><option value="TZ">Tanzania</option><option value="TH">Thailand</option><option value="TL">Timor-Leste</option><option value="TG">Togo</option><option value="TK">Tokelau</option><option value="TO">Tonga</option><option value="TT">Trinidad and Tobago</option><option value="TN">Tunisia</option><option value="TR">Turkey</option><option value="TM">Turkmenistan</option><option value="TC">Turks and Caicos Islands</option><option value="TV">Tuvalu</option><option value="UG">Uganda</option><option value="UA">Ukraine</option><option value="AE">United Arab Emirates</option><option value="GB" selected>United Kingdom (UK)</option><option value="US">United States (US)</option><option value="UM">United States (US) Minor Outlying Islands</option><option value="UY">Uruguay</option><option value="UZ">Uzbekistan</option><option value="VU">Vanuatu</option><option value="VA">Vatican</option><option value="VE">Venezuela</option><option value="VN">Vietnam</option><option value="VG">Virgin Islands (British)</option><option value="VI">Virgin Islands (US)</option><option value="WF">Wallis and Futuna</option><option value="EH">Western Sahara</option><option value="YE">Yemen</option><option value="ZM">Zambia</option><option value="ZW">Zimbabwe</option></select></li><li class="wppb-form-field wppb_billing_postcode"> <label for="billing_postcode">Postcode<span class="wppb-required" title="This field is required">*</span></label> <input class="extra_field_input" name="billing_postcode" type="text" id="billing_postcode" value="" required /></li><li class="wppb-form-field wppb_billing_phone"> <label for="billing_phone">Phone<span class="wppb-required" title="This field is required">*</span></label> <input class="extra_field_input" name="billing_phone" type="text" id="billing_phone" value="" required /></li></ul></li><li class="wppb-form-field wppb-phone" id="wppb-form-element-18"> <label for="Phone">Phone Number</label> <input data-phone-format="{"phone_data":["#","#","#","#","#"," ","#","#","#","#","#","#"]}" class="extra_field_phone " name="Phone" maxlength="70" type="text" id="Phone" value="" /><span class="wppb-description-delimiter">Required phone number format: ##### ######<br></span></li><li class="wppb-form-field wppb-checkbox" id="wppb-form-element-19"> <label for="commerce_ent">Please tick if you currently work for/ are part of a commercial entity which is related to sleep medicine?</label><ul class="wppb-checkboxes"><li class="wppb-hidden"><input type="hidden" value="" name="commerce_ent"></li><li><input value="" class="custom_field_checkbox" name="commerce_ent[]" id="_19" type="checkbox" /><label for="_19" class="wppb-rc-value"></label></li></ul></li><li class="wppb-form-field wppb-textarea" id="wppb-form-element-20"> <label for="research_clinical_interests">Research/Clinical interests (Up to 5)</label> <textarea rows="5" name="research_clinical_interests" maxlength="" class="custom_field_textarea " id="research_clinical_interests" wrap="virtual" ></textarea></li><li class="wppb-form-field wppb-input" id="wppb-form-element-21"> <label for="custom_field_4">Place of Work/ Study <span class="wppb-required" title="This field is required">*</span></label> <input class="extra_field_input " name="custom_field_4" maxlength="250" type="text" id="custom_field_4" value="" required /></li><li class="wppb-form-field wppb-input" id="wppb-form-element-22"> <label for="custom_field_5">Department Name<span class="wppb-required" title="This field is required">*</span></label> <input class="extra_field_input " name="custom_field_5" maxlength="250" type="text" id="custom_field_5" value="" required /></li><li class="wppb-form-field wppb-select" id="wppb-form-element-23"> <label for="Post_Held">Post Held<span class="wppb-required" title="This field is required">*</span></label> <select name="Post_Held" id="Post_Held" class="custom_field_select" required ><option value="Clinician (Medically qualified)" class="custom_field_select_option " >Clinician (Medically qualified)</option><option value="Scientist" class="custom_field_select_option " >Scientist</option><option value="Technologist" class="custom_field_select_option " >Technologist</option><option value="Psychologist" class="custom_field_select_option " >Psychologist</option><option value="Nurse" class="custom_field_select_option " >Nurse</option><option value="Undergraduate Student" class="custom_field_select_option " >Undergraduate Student</option><option value="Postgraduate Student" class="custom_field_select_option " >Postgraduate Student</option><option value="Other" class="custom_field_select_option " >Other</option> </select></li><li class="wppb-form-field wppb-textarea" id="wppb-form-element-29"> <label for="custom_field_9">Please Specify</label> <textarea rows="5" name="custom_field_9" maxlength="" class="custom_field_textarea " id="custom_field_9" wrap="virtual" ></textarea></li><li class="wppb-form-field wppb-select" id="wppb-form-element-24"> <label for="custom_field_6">Facility Type</label> <select name="custom_field_6" id="custom_field_6" class="custom_field_select" ><option value="Hospital" class="custom_field_select_option " >Hospital</option><option value="University" class="custom_field_select_option " >University</option><option value="Private Practice" class="custom_field_select_option " >Private Practice</option><option value="Other" class="custom_field_select_option " >Other</option> </select></li><li class="wppb-form-field wppb-textarea" id="wppb-form-element-30"> <label for="custom_field_10">Please specify </label> <textarea rows="5" name="custom_field_10" maxlength="" class="custom_field_textarea " id="custom_field_10" wrap="virtual" ></textarea></li><li class="wppb-form-field wppb-select" id="wppb-form-element-25"> <label for="custom_field_7">Which of these best describes your facility</label> <select name="custom_field_7" id="custom_field_7" class="custom_field_select" ><option value="Clinical" class="custom_field_select_option " >Clinical</option><option value="Clinical Research" class="custom_field_select_option " >Clinical Research</option><option value="Research" class="custom_field_select_option " >Research</option><option value="Education" class="custom_field_select_option " >Education</option> </select></li><li class="wppb-form-field wppb-radio" id="wppb-form-element-34"> <label for="custom_field_14">Membership Type<span class="wppb-required" title="This field is required">*</span></label><ul class="wppb-radios"><li><input value="Student" class="custom_field_radio " id="student_34" name="custom_field_14" type="radio" required /><label for="student_34" class="wppb-rc-value">Student</label></li><li><input value="Entry Level/Early Years" class="custom_field_radio " id="entry-levelearly-years_34" name="custom_field_14" type="radio" required /><label for="entry-levelearly-years_34" class="wppb-rc-value">Entry Level/Early Years</label></li><li><input value="Standard" class="custom_field_radio " id="standard_34" name="custom_field_14" type="radio" required /><label for="standard_34" class="wppb-rc-value">Standard</label></li></ul></li><li class="wppb-form-field wppb-heading" id="wppb-form-element-28"><h4 class="extra_field_heading">Student Evidence</h4><span class="wppb-description-delimiter">Please send evidence for this membership category either your student card or a letter from your institution to admin@sleepsociety.org.uk</span></li><li class="wppb-form-field wppb-heading" id="wppb-form-element-33"><h4 class="extra_field_heading">Entry Level/Early Years Evidence</h4><span class="wppb-description-delimiter">Please send evidence for this membership category either your Phd Certificate or a letter of ongoing research to admin@sleepsociety.org.uk</span></li><li class="wppb-form-field wppb-checkbox-terms-and-conditions" id="wppb-form-element-38"> <label for="custom_field_17"> <input value="agree" name="custom_field_17" id="custom_field_17" type="checkbox" class="custom_field_toa" required />I have read the Privacy Policy and give my consent to receive communication from the British Sleep Society such as industry news, conference alerts and information the BSS feel is relevant for its' members<span class="wppb-required" title="This field is required">*</span></label><span class="agree_to_terms"></span></li><li class="wppb-form-field wppb-checkbox-terms-and-conditions" id="wppb-form-element-35"> <label for="custom_field_15"> <input value="agree" name="custom_field_15" id="custom_field_15" type="checkbox" class="custom_field_toa" required />I agree to abide by the terms and conditions stated in the British Sleep Society Constitution<span class="wppb-required" title="This field is required">*</span></label><span class="agree_to_terms"></span></li><li class="wppb-form-field wppb-checkbox-terms-and-conditions" id="wppb-form-element-37"> <label for="custom_field_16"> <input value="agree" name="custom_field_16" id="custom_field_16" type="checkbox" class="custom_field_toa" required />I agree to not use BSS Membership for personal or business gain<span class="wppb-required" title="This field is required">*</span></label><span class="agree_to_terms"></span></li><li class="wppb-form-field wppb-recaptcha" id="wppb-form-element-36"><label for="recaptcha_response_field">Captcha<span class="wppb-required" title="This field is required">*</span></label><div id="wppb-recaptcha-element-pb_register1" class="wppb-recaptcha-element "></div></li></ul><ul><li class="wppb-form-field wppb-send-credentials-checkbox"><label for="send_credentials_via_email"><input id="send_credentials_via_email" type="checkbox" name="send_credentials_via_email" value="sending"/>Send these credentials via email.</label></li></ul> <p class="form-submit" > <input name="register" type="submit" id="register" class="submit button" value="Register" /> <input name="redirect_to" type="hidden" value="https://sleepsoc.wpengine.com/product-category/membership-subsciption/" /> <input name="action" type="hidden" id="action" value="register" /> <input name="form_name" type="hidden" id="form_name" value="full" /> <input name="form_id" type="hidden" id="form_id" value="355" /> </p> <input type="hidden" id="register_full_nonce_field" name="register_full_nonce_field" value="90fd97500b" /><input type="hidden" name="_wp_http_referer" value="/register-for-membership/" /> </form> </p> </div> </div> </div> </div> </div> </div> <div class="fl-col-group fl-node-7pcg1yk4m3qd" data-node="7pcg1yk4m3qd"> <div class="fl-col fl-node-9qo2ucip8ynj fl-col-bg-color" data-node="9qo2ucip8ynj"> <div class="fl-col-content fl-node-content"></div> </div> </div> </div> </div> </div> </div> </div> </article>  </div> </div> </div> </div> <footer class="fl-page-footer-wrap" itemscope="itemscope" 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