Please enrol me as a member of UKCS

Name .....................................................................

Position .....................................................................

Address .....................................................................

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Tel No. ......................... Fax No. ..........................

E-mail .....................................................................
 
 

Please tick the appropriate box:

 

I enclose a cheque for £10 to cover membership up to October 2009

 

I enclose a cheque for £50 to cover membership up to October 2015

Please make cheques payable to ICS(UK)(this will change soon)

 

I have arranged for payment by standing order (£5 immediately and then annually from 1st October 2009)

I enclose a cheque for £50 to cover membership up to October 2015

You can arrange with your bank for direct payment into the Society's account via a standing order. If you wish to pursue this option the details of the Society's account are:

Account Name: International Continence Society (UK)

Account Number: 41289314

Sort Code: 40-31-30

Bank address: HSBC, University Branch, Thorncliffe House, 348 Oxford Road, Manchester. M13 9NG

Signed ...................................................... Date ...........................
 
 

Please tick this box if you do not wish to have your mailing address passed on to other

organisations or individuals involved in continence.