Individual Membership Application Form
Individual Membership Application Form
Individual Membership Application Form
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<strong>Membership</strong> <strong>Application</strong> <strong>Form</strong>Surname ……………………………………………………Forename(s) ………………………………………………..Term/Home address ……………………………………….Title (Dr/Mr/Mrs/Ms etc.) ………………………Nationality ……………………...……………….Date of birth ………………………...…………..Address Line 2 ..……………………………………...…... Home telephone …………………….……….…Address Line 3 ..…………………………………...……... Mobile number …………………………………Postcode ………………………....................……… Country …………………………………………Email address…………………………………………………………………………………………………...Category of membership (please select which category you are applying for) <strong>Individual</strong> (non-voting) <strong>Individual</strong> (voting – CV & sponsorship required)CompanyDepartmentJob titleAddress Line 1Address Line 2Address Line 3…...….…………………………………………………………………….………………………...………………………………………………………………………………………...…………………………………………………………………………………………………...…………………………………………………………………………………………………...…………………………………………………………………………………………………...………………………………………………………………………………………………Postcode ...…………………....................……… Country …………………………………………Unless specified otherwise, all mailings will be posted to your home address and you will be affiliated to aregion closest to your home address.Your CVIf you are applying for <strong>Individual</strong> <strong>Membership</strong> with voting rights you must include your up-to-date CV and haveyour application sponsored by two <strong>Individual</strong> Members with voting rights.Sponsor’s Name ………………………………………. Sponsor’s Name ………………….……...…………..DECLARATIONI declare that I will observe the provisions of the Charter and By-laws and do the upmost in my power topromote the welfare and maintain the dignity of SDC as long as I remain a member.Applicant’s signature …………………………………Date ……………/……………/………
<strong>Membership</strong> <strong>Application</strong> <strong>Form</strong>All payments should be made in Pound Sterling (£) I would like an invoice Pay by Direct Debit (please contact members@sdc.org.uk or go to www.sdc.org.uk for a form) I enclose a cheque for £……………. sterling Please debit my credit/debit card for £……………. sterlingVAT NumberCard type:Visa Debit / Visa Credit / Mastercard / American ExpressCard NumberM M Y YStart Date Exp DateM M Y YSecurity Code (Last 3 digits on back of card)Cardholder DetailsTitle (Dr/Mr/Mrs/Ms etc.) ………………………SurnameForename(s)……………………………………………………………………………………….....……………………………………………………………………………………….....House Name/NumberAddress Line 2Address Line 3……………………………………………………………………………………….....………………………………………………………………………………………….……………………………………………………………………………………..…...Postcode 3 ..…………………………………...……... Country …………..……………………Signed ByApplicant’s signatureDate…………………………………………....……………/…………FOR OFFICE USE ONLY:<strong>Form</strong> received:Payment received:<strong>Membership</strong> number:
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