Membership renewal

• Membership of ULEMHAS costs £15.00 per year

• For a joint membership (one address, one posting) the cost is £22.00

• Just print this page, fill in your details, and post it with your cheque to the address at the bottom (if you have any difficulty with printing, open a printable PDF file here)

	Title	Forename(s)		Surname
Your name:
Partner's name: (For joint membership)
Address: (if changed)
Post Code:
Email:
Telephone: (if changed)	(Day) (Evening)
Student No.			(If a current Birkbeck student)
Your details may be passed to the Birkbeck Students' Union in order that ULEMHAS may continue to benefit from affiliation. ULEMHAS and the Students' Union abide by the Data Protection Act and your details will not be passed on to any other organisation.
I wish to renew my membership; I enclose a cheque for £15.00 made out to ULEMHAS   (Tick one) We wish to renew our membership; we enclose a cheque for £22.00 made out to ULEMHAS
Signed: Date: Send to: Lois Garnier Membership Secretary, ULEMHAS 9 Fernside Court Holders Hill Road London NW4 1JT

Updated: 09 February 2012