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Administrator
BSEM
c/o New Medicine Group
144 Harley St
London W1G 7LE

Applicant details

Name _________________________________________________________________

Email address ________________________________________

Land line ___________________________ Mobile __________________________

Postal address _________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

_____________________________________________________________________

I would like to:   [ ] apply for membership    [ ] renew my membership   (please tick one)

for the period 1 Jan 20___  to 31 Dec 20___  or part thereof.

Signature _________________________________________

Please tick one of the following options:

[ ] Full £100    [ ] Scientific £100    [ ] Associate £80

[ ] Overseas full £80    [ ] Retired full (no voting rights) £80    [ ] Student £55

Notes:

1. A reduced fee may be approved in cases of financial hardship – please enquire with the BSEM office

2. A 20% surcharge is payable (by order of the Treasurer) by members who do not supply their email addresses, to cover postage and administration.

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

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)

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.