BAS Membership

Please update your current details here so we can keep our records up to date.

 

You can download the membership form in Microsoft Word format here, a PDF, or print this page and fill it in.

 

BAS Application for membership

Surname
First Names
Professional Qualifications
Work Address
Postcode
Tel
Fax
Email
Position
Interests (please give up to 5 keywords)

How did you hear of the BAS?

Colleague /other society /work-place /BAS course /journal /other (please state):

     _________________________________________________________

SUBSCRIPTION RATES (from Jan. 2007)

Tick as appropriate

Full member (eligible for travel grants + discounted registration at meetings)   Discounted rate if paying by -standing order	£25.00 / year £24.00 / year
Student member (eligible for travel grants + discounted registration at meetings) Discounted rate if paying by -standing order	£15.00 / year £14.00 / year
Retired member Discounted rate if paying by -standing order	£15.00 / year £14.00 / year

Your subscription may be paid by standing order (at a discounted rate) or by cheque (international money order). Tick as appropriate.

I wish to pay by standing order (at a discounted rate)
I wish to pay by cheque (payable to THE BRITISH ANDROLOGY SOCIETY)

STANDING ORDER INSTRUCTION

Bank
Address
Account name
Sort code
Account number

Please pay to : THE BRITISH ANDROLOGY SOCIETY
National Westminster Bank Plc
Sort Code 60-17-12 Account No. 66948150
IBAN number: GB65 NWBK 6017 1266 9481 50
Swift code: NWBKGB2L

the sum of £24.00 / £14.00* on 01 / __ / __ (next calender month) and
the sum of £24.00 / £14.00*on 31st January each year until further notice.
(*Delete as appropriate)

Signature :____________________________________________________

Date :________________________________________________________

Please return this FORM with your CHEQUE or STANDING ORDER to -
Dr Alireza Fazeli

Membership Secretary, British Andrology Society
Academic Unit of Reproductive and Developmental Medicine

The University of Sheffield

Level 4, Jessop Wing, Tree Root Walk

S10 2SF Sheffield

United Kingdom