Sheffield Medico-Chirurgical Society

Please click on the links below

STUDENT MEMBERSHIP FORM PDF FORMAT
STUDENT MEMBERSHIP FORM
Medchi+student+application
Medchi+student+application.pdf
Adobe Acrobat document [91.5 KB]
MEMBERSHIP FORM PDF FORMAT
MEMBERSHIP FORM
Sheffield+Medici+membership+application
Sheffield Medchi application.pdf
Adobe Acrobat document [296.2 KB]
STANDING ORDER PDF FORMAT
STANDING ORDER
Med+Chi+standing+order
Med+Chi+standing+order.pdf
Adobe Acrobat document [23.8 KB]
Or
Print the page below, complete the form and send it to administrative secretary
Membership subscription for qualified Medical and Dental Professionals is £30 per annum payable by cheque or as standing orders payable on the first of October annual.
Special concessionary subscription rates for Students
Student Membership is free for the first year and membership covering the whole course is £15.00, payable in advance at the beginning of the course. If you choose to pay annually, the subscription is £5.00 per annum.
Please enclose payment of £5.00 as annual subscription or £15.00 for the whole course. Cheques to be made payable to 'Sheffield Medico-Chirurgical Society.. If you wish subsequent subscriptions to be paid by standing order, please complete the mandate below.
Application form
Please complete in CAPITAL LETTER
Surname....................................................................................................
Forenames........................................... .... Title................................
Address.............................................. Tel No.................................
....................................................... Postcode............................
Email……………………………………………………………………………………………………............ ......
Qualifications…………………………………… Year of Qualification.............
Specialty…………………………………………...................................................................
I wish to become a member of the Sheffield Medico-Chirurgical Society.
Signed.................................................................................................... Date.......................................
Please enclose payment of as stated above as annual subscription. Cheques to be made payable to 'Sheffield Medico-Chirurgical Society'. If you wish subsequent annual subscriptions to be paid by standing order, please complete the mandate below. We will forward this to your bank.

The completed form should be sent, with payment, to the Administrative Secretary :
(Mrs Linda Norcliffe, 16 Chapelfield road, Thorpe Hesley, Rotherham S61 2SP

Standing Order
To the Manager.................................................Bank
Address..........................................................................................................................................................
......................................................................................................................................................................
Please pay to the Sheffield Medico-Chirurgical Society, Account No. .................... the ........................plc, High street,
................. Post Code....................., sort code .............. on the first of October each year until further notice the sum of
£5 (five pounds) / £30 (thirty pounds) and debit my account with the same.
This order cancels any previous instructions for the payment of subscriptions to the Sheffield Medico-Chirurgical Society.
Signature...........................................................................................................................................
AccountName.....................................................................................................................................
Sort Code.................................................... Account No .....................................................................
Date.....................................................................................................................................................
PLEASE NOTE THAT THIS ORDER DOES NOT BECOME OPERATIVE UNTIL 1ST OCTOBER AFTER DATE OF SIGNATURE.
FIRST PAYMENT TO BE MADE ON OCTOBER...............................................
OR
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