Biomedical & Clinical Engineering Association of Ireland
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Either print this form and forward to the Treasurer with the appropriate fee enclosed

OR

go to the on-line procedure HERE

Application for Membership 2008.
Membership category applying for:
Surname: Membership # (renewals only):
First Name: Proposed by:
Position: Seconded by:
Contact Address line 1:
Contact Address line 2:
Contact Address line 3:
Contact Address line 4:
Telephone #: Fax #:
E Mail: Mobile #
Area/s 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

Occasionally the BEAI is contacted by companies/organisations that wish to correspond with our membership. If you wish the BEAI to forward your details to interested parties please tick this box..
Date Accepted: (BEAI use only)..../..../20..