The Orthodontic National Group for Dental Nurses & Therapists application for membership



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The Orthodontic National Group



for Dental Nurses & Therapists


APPLICATION FOR MEMBERSHIP

PLEASE PRINT NAME AND ADDRESS CLEARLY IN BLOCK CAPITALS AND BLACK INK.


FULL NAME (Mr/Mrs/Miss)
ADDRESS (HOME)
Post Code:
GDC number
TELEPHONE No’s (HOME) (WORK)
Email Address:
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”




I would like access to online CPD I do not require online CPD



I do not wish to receive mailings other than those directly from the ONG - BOS.


SIGNATURE DATE
Are you a - (please circle)

Therapist Orthodontic Dental Nurse Dental Nurse Work in a DCP capacity.


Are you working in - (please circle)
Hospital Community Dental Practice Specialist Orthodontic Practice.
Should your name change or your address please remember to notify the ONG Membership Secretary.

Should you not receive an ONG News within any four month period, please first check that you are still a current member

(membership lapses after 12 months), then contact anniegetyourbraces@yahoo.com
All (payments) cheques and forms to be sent to:

The Orthodontic National Group, 12 Bridewell Place, London EC4V 6AP



Email: ann.wright@bos.org.uk (01/17 website)


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