ABERDEEN MEDICO-CHIRURGICAL SOCIETY by 2m9tDq

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									         Aberdeen Medico-Chirurgical Society
                                           MEMBERSHIP DETAILS



Title:                           Name in full:

Designation:
(e.g. Consultant/ Senior Lecturer/GP Principal/Associate Specialist/SpR/SHO/Foundation Doctor)

Home Address:



Postcode:                                        E-mail Address:

Mailing Address:
(if different from above)



Telephone No.:                                               Date of Birth:


I wish to receive communications by e-mail where possible: Yes                ‫ٱ‬   No     ‫ٱ‬

Annual subscriptions are paid by Direct Debit annually. A form will be sent to you on acceptance
of your application to membership.

a) Consultant, Senior Lecturer, GP Principal and Associate Specialist             £120
b) Foundation Doctor                                                              Free
c) Other grades                                                                   £ 50


Please return this form to:                   Aberdeen Medico-Chirurgical Society
                                              Medical School
                                              Foresterhill
                                              ABERDEEN
                                              AB25 2ZD

                                              Tel: 01224 552737 (or Ext. 52737)
                                              Fax: 01224 550637
                                              E-mail: medchi.admin@abdn.ac.uk
                                              Website: www.med-chi.co.uk

For Society’s use only:
Date of Receipt:                           Membership No:              Subscription Rate: £


C/MedChiForms/Application form (July 07)

								
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