Membership Application Form
As this form requires the signature of one proposer, it is not provided as an on-line form. Instead, print this page, complete, and return by post.
NAME (& TITLE) .........................................................................................
PROFESSIONAL ADDRESS.......................................................................
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TELEPHONE ................................................................................................
FAX ................................................................................................................
E-MAIL .........................................................................................................
MEMBERSHIP - FULL / STUDENT*
* delete as appropriate. The fee is £15 for students and £25 for full members.
PERSONAL RESEARCH INTERESTS
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If you wish, you can avoid the need for writing cheques by completing the following form.
BANKER'S ORDER FORM
Date...........................
To...............................................................................................Bank
Limited
(Full Address)...............................................................................................................
.....................................................................................................................................
.....................................................................................................................................
Please pay annually on 1st January, starting from 2006 , the sum of
* £25 (Full and Corresponding Members)
* £15 (Student Members) (*delete as appropriate)
until this order is revoked, to:
The British Society of Protist Biology,
Account No. 0212081,
Lloyds TSB, (Sort Code 30-97-71)
Sloane Square branch,
31 Sloane Square,
London,
SW1W 8AG.
PLEASE REVOKE ANY PREVIOUS ORDER TO THIS SOCIETY.
Signed ..............................................................................................................
Name (Block Capital) ......................................................................................
Address ............................................................................................................
............................................................................................................................
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Account Number ..............................................................................................
Please return these forms to the membership secretary:
Dr Stephen Coupe
The James Starley Building
Coventry University
Priory Street
Coventry
CV1 5FB