Membership no.
Microbiology
Microbiology
society for general
ciety
s oMembership no. for g e n e r a l
www.sgm.ac.uk
Application for Corporate Membership
for subscription year January to December 2012
Corporate Membership of the Society for General Microbiology is open to companies and other bodies with interests
in microbiology. Corporate Members are entitled to:
j Receive the Society publication Microbiology Today
j Receive discounted rates for advertising and inserts in Microbiology Today and for exhibiting or placing inserts at Society meetings
j Acknowledgement as sponsors in Microbiology Today, at Society meetings and on the Society website
j Send two delegates to each SGM meeting at members’ registration rate
1. Organization
Name of organization
Department
Address
Postcode
Website
2. Named contact
Surname Title (Prof/Dr/Mr/Mrs/Miss/Ms)
Forenames Academic qualifications
Job Title
Telephone no. ext. Fax
Email
3. Profile
Please give a short description of your organization’s activities, products and services etc. including interests in microbiology (or attach
separate sheet).
4. Membership/Declaration
We wish to apply for Corporate Membership of the SGM
h Tier 1 (SMEs only as defined by Companies House): £350.00 h Tier 2: £500.00
1. We agree to be bound by the Memorandum and Articles of Association and the Bye-laws of the Society, as amended from time to time.
2. Data Protection Act 1998. We understand that the information provided by us on this form will be processed by the SGM and will
be used for the purposes of (i) providing us with the benefits of membership and for billing and subscription renewal; (ii) providing
information on products and services that is included in regular mailings of Microbiology Today; (iii) providing us with email alerts
about Society activities, unless we have indicated otherwise below.
If you do not wish to receive email alerts about Society activities, please tick here h
Signature of applicant Date
(on behalf of organization)
PTO
5. Payment
Payment will be accepted only in £ sterling.
h We enclose a cheque (made payable to the ‘Society for General Microbiology’) for h £350.00 h £500.00
h Please send an invoice – Purchase Order No.
h Payment can also be made via Direct Debit/BACS. A Direct Debit form can be downloaded from our website at
www.sgm.ac.uk/DD.pdf. BACS details will be sent upon request.
h We wish to pay by Debit/Credit Card. A charge of £1.50 will be added if paying by Credit Card to cover the
transaction fee incurred by the Society. No cards other than those indicated below can be accepted.
I authorize you to debit my Debit/Credit Card Account to the value of £ in respect of the current year’s membership fee.
Signature Date
Cardholder’s address (address to which your Credit Card statement is sent)
Card type (please tick one box only)
h Mastercard Credit h Visa Credit h Mastercard Debit h Visa Debit h Maestro/Visa Electron
My Debit/Credit Card number is:
Card security
code
Valid Expiry Issue no.
from date where applicable
Company Limited by Guarantee Send completed form, together with remittance, to:
Registered in England No. 1039582 Society for General Microbiology (Membership Office), Marlborough House,
Registered Office as opposite Basingstoke Road, Spencers Wood, Reading RG7 1AG, UK
Registered as a Charity in England [t +44 (0)118 988 1803; f +44 (0)118 988 5656; e members@sgm.ac.uk; w www.sgm.ac.uk]
and Wales, No. 264017
A charity registered in Scotland,
No. SC039250