Membership Proposal/Application Form

Name:

Position:

Academic qualifications:

Address:

Phone:

Fax:

E-mail:

Research interests (5 keywords):

Membership of other scientific societies:

Proposers (names and signatures of current Anatomical Society members):

(1):

(2):

I wish to apply for Ordinary Membership of the Anatomical Society of Great Britain and Ireland.

Applicant's signature:

A hard copy print-out of this form or as an e-mail attachment should be completed and sent to:

Dr Sam Cobb Honorary Assistant Secretary (Membership),The Anatomical Society of Great Britain and Ireland c/o Portland Customer Services, Commerce Way, Colchester, Essex, CO2 8HP, UK. Tel: +44 (0)1206 796351. Fax +44 (0)1206 799331. E-mail: asgbi@portland-services.com

All applications must be supported by a current Curriculum Vitae.

Persons registered for a higher degree who wish to apply for Membership at the reduced subscription rate should also include a letter from their Supervisor or Head of Department confirming their status.