Name ________________________________________
Permanent Address ________________________________________
Postcode
____________________
Telephone No.
_________________
Fax No. _________________
Email __________________________________________________
Term-time Address (for correspondence, if different)
_________________________________________________________
Postcode
____________________
Email __________________________________________________
Name of College ________________________________________
Course being followed ______________________________________
To be completed by the course tutor/college administrator:
I confirm that the above named individual is a full-time student
on the course stated.
Name
_______________________ Date ____________________
Position Held ________________________________________
Category of membership required (01 January 2009
to 31 December 2009): (please circle one)
|
A
£18.75
|
B
£33.00 |
C
£27.50 |
A + B
£39.00 |
B + C
£42.25 |
A + B + C
£51.25 |
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 ________________________
|
