PLEASE PRINT NAME AND ADDRESS CLEARLY IN BLOCK CAPITALS AND BLACK INK.
FULL NAME (Mr/Mrs/Miss)
TELEPHONE No’s (HOME) (WORK)
Annual Membership Fee payable 1st January. Membership runs from Jan – Dec each year Full Membership fee if no Direct Debit returned herewith £35 Discounted Membership Fee when accompanied by a Direct Debit £30 I enclose a cheque for £35.00 (sterling) if no accompanying Direct Debit returned to cover my annual subscription (cheques and postal orders should be made payable to “British Orthodontic Society”).
OR I enclose a cheque for £30.00 (sterling) together with a completed direct debit form which will be used to collect my subscriptions from 2nd January 2018 onwards. Cheques and postal
orders should be made payable to “British Orthodontic Society”