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Wild Thorn
orthopaedic society

Print and post for membership

Criteria For Membership

 

Membership is only available to doctors with a registerable qualification in the UK. All doctors with an interest in musculoskeletal medicine are welcome to join.

 

There are two levels of subscription:

1. "Ordinary" - for members with an interest in the subject, 50 pa plus       20 if you wish your details to be entered on the referral page of the BIMM website.

2. "Higher Rate" - for members earning more than 10,000 pa from             musculoskeletal practice,   120 pa.  (Entry on the web site included if desired).

 

 

Please complete the form below:

   

Title..........Name and Initials ..........................Surname.............................................

Qualifications.................................................G.M.C.no ...........................

Partners First Name (for inclusion in members book)............................................................

Home ..................................................          Practice .............................................
   
Address...........................................             Address.................................................
    
..................................................                   ........................................................
           

Post Code.....................................              Post Code ................................

Telephone No.............................               Telephone No.....................................     
Fax:No..........................................            Fax:No................................................ E.mail.............................................           E.mail.................................................

 

STANDING ORDER MANDATE

 

To : The Manager  ..............................................Bank

Address............................................. Bank Sort Code........ - ........ - ........

...............................................           Account Name .....................................

...............................................           Account No.........................................

Post Code................................                       

                                                                            (delete as appropriate)

Please pay, from the above account, the sum of  50:00 / 120 now

and on the same date annually until further notice to :       

 

THE BRITISH INSTITUTE of MUSCULOSKELETAL MEDICINE

 

Bank Sort Code 30 - 96 - 18               Account No.  0186854

 

LLOYDS TSB Bank P.L.C   Old Market Street, Nottingham, NG1 6FD

 

Signed ............................................................ Date ..............................

 


 

 

Type of Practice:

 

NHS GP (single handed / partnership) .........................................................................

 

Hospital (state grade) .............................................................................................

 

Private Practice (GP / Consulting) ..............................................................................

 

Occupational Medicine ...........................................................................................

 

Other ................................................................................................................

 

Please give a brief C.V. (indicating type of practice and time spent in each).

 

 

 

Please state your interest and /or experience in Musculoskeletal Medicine

(including how you initially got involved).

 

 

 

Please state how you first heard of BIMM.

 

 

Signed.................................................       Dated...........................................

 

Please return to BIMM, 34 The Avenue, Watford, Herts. WD1 3NS, together with standing order or cheque.








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