BAS Membership

Please update your current details here so we can keep our records up to date and email them to secretary@britishandrology.org.uk.

 

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

 

Office to complete:

Please pay to : THE BRITISH ANDROLOGY SOCIETY
Bank Name:
Sort Code:                    Account No.
IBAN number:
Swift code:

the sum of £24.00 / £14.00* on 01 / __ / __ (next calendar 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
Chairman, British Andrology Society
Academic Unit of Reproductive and Developmental Medicine
The University of Sheffield
Level 4, Jessop Wing,
Tree Root Walk
Sheffield, S10 2SF
United Kingdom