Online Membership Application
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If you have technical difficulties, please inform the webmaster Charles Florey 

Please be sure to complete all the fields marked with an asterisk (*)
When you have completed the form, click the Submit button.

  

* I have read the constitution and agree to abide by the principles and bye-laws of the Society. (please tick the box)

Title:    First Name(s) *  Surname:*

Surname used for Bank account if different from above:  

What is your gender?           Date of Birth *
                                                                              Day/Month/Yr         (e.g. 23/09/56)

CONTACTS 
  Email:  * (If you do not have one, insert 'None' here)

  (Please complete at least one of your addresses below, but preferably both)

  Address at work:       

Department:

*
Institution:
Street:
(continued)
Town:
Post Code:
Country:
Tel:  

  Address at home:

Line1:

* 
Line 2:
Line 3:    
Postcode:
Country
Tel:     
Preferred address for mailing

 

 

 

 

 

 

 

  

 

Present Post:        *

Areas of Interest:
                       1: *
                       2:
                       3:

Proposer 1's name and address (up to 255 characters available):

                                  *

Proposer 1's email:   * (You may insert 'None' here)

You may include a second proposer, but it is not necessary

Proposer 2's name and address (up to 255 characters available):

                                  

Proposer 2's email:    (You may insert 'None' here)

 Please tick this box if you do not wish any of your particulars on the Society's database to be disclosed to third parties (e.g. academic publishers; university or government departments wishing to identify people with a particular expertise).

  

Please remember to send in your cheque and standing order (see previous page)