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Dear BSEM

I would like to: apply for membership [ ]; renew my membership [ ]

for the period 1 Jan 2011 to 31 Dec 2011 or part thereof.

Signature _________________________________________

Please tick one of the following options:

Full £100 [ ]

Scientific £100 [ ]

Associate £80, but a reduced fee applies in cases of financial hardship – please enquire with the BSEM office [ ]

Overseas full £80 [ ]

Retired full (no voting rights) £80 [ ]

Student £55 [ ]

Description of membership types:

Full membership is open to registered medical, dental and veterinary practitioners. Full members have voting rights in the general meetings and elections of the BSEM.

Scientific membership is open to non-medically qualified scientists who have made a contribution to the fields covered by the BSEM. Scientific members have voting rights in the general meetings and elections of the BSEM.

Associate membership is open to non-medically qualified complementary practitioners (such as nutritionists and
osteopaths) and to patients, carers and knowledgeable members of the general public who wish to support the work of the BSEM.

Overseas full membership is open to registered medical, dental and veterinary practitioners outside the UK.

Retired full membership is available on request only, and on the relinquishing of voting rights – please enquire with the BSEM office.

Student membership is open to medical and non-medical students.

New members: please enclose a copy of your professional certificate in support of your choice of membership category.

Contact details

Name _____________________________________________________________________

Email address _____________________________________________________________________

Land line _____________________________________________________________________

Mobile _____________________________________________________________________

Postal address _____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

Payment method

I enclose a cheque for £___.__ made out to BSEM [ ]

I have made a telephone credit-card payment to the BSEM via The Diagnostic Clinic on 0207 009 4650 (please note that a 2.5% administration charge will be levied) [ ]

An extra 20% surcharge (by order of the Treasurer) is payable by members who do not supply their email addresses.

Please return to Christina Winters, Administrator, BSEM, c/o New Medicine Group, PO Box 3AP, London W1A 3AP