RETIREMENT DECLARATION

							                          LOWER AND MIDDLE INCOME (LAMI) COUNTRIES*
                          APPLICATION FOR REDUCED RATE OF SUBSCRIPTION
Members of the College who live and work in a LAMI country (equivalent to countries in Bands C or
D*) can apply for their annual subscription rate to be reduced to £30 if their monthly income in 2013
is below £1,000.

I wish to apply for the reduced overseas subscription rate for the period January ~ December
2013. I hereby notify the College that my monthly earnings are less than £1,000.


Name ..........................................................................................
(Please complete in block capitals)


Address ...........................................................................…

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Contact Email Address.........................................................................


Signature ..................................................................................


Date ............................                      Membership Reference No. ............................

Please return this form to:
Membership Data Office, The Royal College Of Psychiatrists, 17 Belgrave Square, London, SW1X 8PG.




     DATA PROTECTION STATEMENT
The College’s Data Protection Statement can be viewed at http://www.rcpsych.ac.uk/dataprotection.



*The countries in Bands C or D that are eligible for the discount are: Afghanistan, Albania,
Armenia, Bangladesh, Benin, Bhutan, Bolivia, Burkina Faso, Burundi, Cambodia, Cameroon, Cape
Verde, Central African Republic, Chad, Comoros, Congo, Côte d'Ivoire, Djibouti, Egypt, El Salvador,
Eritrea, Ethiopia, Fiji, Gambia, Georgia, Ghana, Guatemala, Guinea, Guinea-Bissau, Guyana, Haiti,
Honduras, India, Indonesia, Iraq, Kenya, Kiribati, Korea- Dem Rep., Kyrgyz Republic, Lao PDR,
Lesotho, Liberia, Madagascar, Malawi, Mali, Marshall Islands, Mauritania, Micronesia, Moldova,
Mongolia, Morocco, Mozambique, Myanmar, Namibia, Nepal, Nicaragua, Niger, Nigeria, Pakistan,
Papua New Guinea, Paraguay, Philippines, Rwanda, Samoa, São Tomé and Principe, Senegal, Sierra
Leone, Solomon Islands, Somalia, Sri Lanka, Sudan, Swaziland, Syrian Arab Republic, Tajikistan,
Tanzania, Timor-Leste, Togo, Tonga, Tunisia, Turkmenistan, Uganda, Ukraine, Uzbekistan, Vanuatu,
Vietnam, West Bank and Gaza, Yemen Rep., Zambia, Zimbabwe

If you have already paid your 2013 Subscription then please attach a covering note stating
whether you would like the difference to be refunded or left as credit on your account for
next year. In the absence of a clear indication any difference will be left as credit.

Claims cannot be backdated for previous years.