Biomedical & Clinical Engineering Association of Ireland, membership form.


Either print this form and forward to the Treasurer with the appropriate fee enclosed or pay via paypal buttons below and e-mail details as per form to the Treasurer and pay via the PAYPAL buttons below.

Application for Membership 2008.

Surname:	.	Membership:	.
First Name:	.	Proposed by:	.
Position:	.	Seconded by:	.
Contact Address line 1:	.	Date Accepted:	..../..../20..
Contact Address line 2:	.
Contact Address line 3:	.
Contact Address line 4:	.

Telephone #:	.	Fax #:	.
E Mail:	.	Mobile #	.

Area of Interest:

Please select the membership category for which you are applying:

Full Member:	€ 30.00
Associate Member:	€ 20.00
Retired Member:	€ 20.00
Student Member:	€ 10.00
Corporate Member:	€ 300.00

Signature:

Date:

Please make cheques payable to The Biomedical Engineering Association of Ireland and forward to Treasurer.
Membership will be terminated if renewal is not submitted prior to April 30th of the renewal year.
Membership requests received after this date will be subject to executive committee ratification

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