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SRS Application Form

Print out the form and send it to the SRS Secretary,
at the address on the Contacts page. Please also complete & enclose the Standing Order Form. Your application will be submitted at our next Council Meeting and we will be in touch thereafter.

Applicant:

Name:
Qualifications:
Specialty: Radiodiagnosis
Radiotherapy & Oncology
Medical Oncology
Other
Present Appointment:
Institution:

Corresponding (Work) Address:

Address 1:
Address 2:
Town or City:
Postcode:
Tel:
Fax:
E-mail:

Home Address:

Address 1:
Address 2:
Town or City:
Postcode:
I wish to apply for membership of the Scottish Radiological Society
 
Signature:
 
Sponsorship of current SRS member:
 
Signature:
Name:
 
Date:
 
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© The Scottish Radiological Society
Author : Dr A C Downie