Faculty of Radiologists
Royal College of Surgeons Ireland
121 – 122 St Stephens Green
Dublin 2
Professional Competence Scheme Application Form
Title
Professor, Doctor, Mr, Ms, other
Forename
Middle Name(s)
Family name
Gender
Date of Birth
Place of Birth
Email Address
Home Telephone Number
Mobile Telephone Number
Specialty: Diagnostic Radiology Radiation Oncology
Country of Qualification & Name of Training Body
Place of Work
Preferred Address: Work Home Other
Address
Irish Medical Council Number
Are you currently on the Irish Medical Council:
Division of Radiology Specialist Register General Register
Specialist Training Division Supervised Division
Are you requesting enrolment to the Faculty of Radiologists Professional Competence Scheme for the first time?
Yes/No
Have you been refused enrolment to the Faculty of Radiologists Professional Competence Scheme in the past year?
Yes/No
Subscription Details – please select the relevant options
• Fellows of the Faculty of Radiologists (FFR RCSI)
o Examination Ad eundem
o Consultant Status Non-consultant Status
o Full-time Part-time*
o Overseas†
o Retired‡
• Members of the Faculty of Radiologists
o Consultant Status Non-consultant Status
o Full-time Part-time*
o Overseas†
o Retired‡
• Non-fellows/members
* This includes all those working ≤ 20 hours per week and those not working but wishing to avail of PCS.
Supporting documentation may be requested upon application
† Please note that PCS registration with the Faculty is not required if practicing for less than 30 days per annum in
Ireland, or participating in overseas CPD structures in line with Medical Council standards
‡ Please note that PCS registration is required if you are on the Irish Medical Register
Annual Subscriptions & PCS Fees
1. Fellows/Members of the Faculty of Radiologists in full-time practice in Ireland:
(i) Consultant Status:
Annual subscription (not including PCS registration): €350
(ii) Non-Consultant Status:
Annual subscription (not including PCS registration): €250
2. Fellows/Members of the Faculty of Radiologists in part-time practice in Ireland:
Annual subscription (not including PCS registration): €200
3. Overseas Fellows/Members of the Faculty of Radiologists:
Annual subscription (not including PCS registration): €250
4. Retired Fellows/Members of the Faculty of Radiologists:
Annual subscription (not including PCS registration): €50
5. PCS Fees for Fellows/Members in good standing:
€150
6. PCS Fees for non-Fellows/Member:
€250 annual fee plus €250 once-off charge for new registrants
7. Associate Members
Annual Subscription: €50
Faculty Subscription & Professional Competence Fees Payment Form
Payment by card cheque enclosed
If paying by credit card, please complete the credit card details below and return to the
Faculty of Radiologists Office at the address below
I authorise deduction of €________ from my:
Visa: Access / Mastercard: Debit Card:
Card Number: ______________________________________________________
Expiry Date: ________________ CVV: ________________
Name (block letters): ______________________________________________
Address: ______________________________________________________
_____________________________________________________
______________________________________________________
Email: ______________________________________________________
Signature: _____________________________ Date: __________________
If you have any enquiries please contact:
The Faculty of Radiologists
Royal College of Surgeons in Ireland
123 St. Stephen’s Green
Dublin 2
Tel: 01-402 5128 ¦ Fax: 01-402 2466
E-mail: pcs@radiology.ie ¦website: www.radiology.ie
