Name
__________________________________________________
Mr/Mrs/Miss/Ms/Other
__________
Address _________________________________________________
Postcode
____________________
Telephone No.
_________________
Fax No. _________________
Email __________________________________________________
Name of Institution ________________________________________
Current Post Held ________________________________________
Daytime Telephone No. _____________
Fax No. ______________
Category of membership required (08 January 2009
to 31 December 2009): (please circle one)
A
£37.50 |
B
£66.00 |
C
£55.00 |
A + B
£78.00 |
B + C
£84.50 |
A + B + C
£102.50 |
Please refer to the Membership page for details of supplements
for addresses outside the U.K.
[ ] I enclose a cheque for £__________
[ ] Please debit my visa/mastercard
Number
____________________________________________
Security Number
____________ Valid From/Issue No.________
Expiry date ________
Signature ________________________
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