Membership Application Form

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Membership is open to members of the Royal College of Veterinary Surgeons and the subscription is £5 per year, due on election and on each subsequent 1st January. Please complete this form, print it and post it together with your cheque for £5 (payable to "NEVA"), to Joint Honorary Secretary Christine Shield, c/o Station Bungalow, Main Rd, Stocksfield, Northumberland, NE43 7HJ.

Date of application:
Title: Mr/Mrs/Miss/Ms/Dr (delete as applicable)
Full name:
Qualifications:
Address for correspondence:
Post code:
Daytime phone number:
Place of work, if different from above:
Proposer Seconder
Name:
Address:
Signature: ___________________________________________ ___________________________________________
Declaration
I wish my name to go forward for election to membership of the North of England Veterinary Association at the next General Meeting, and enclose my first year's subscription of £5. I understand that as a member of the Association it is my responsibility to ensure that my subscription is paid each year, to let the Secretaries know if my address should change at any time, and to tender formal resignation if at any time I should wish no longer to be a member for any reason.
Signature of applicant: ___________________________________________________

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