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AGMS
Personal Data
Title:
Name:
*
Email:
*
Telephone:
*
Fax:
Address:
*
Fee
Yes, I wish to aply for membership of the Anglo-German Medical Society. I enclosed a cheque with my annual fee to this form. I understand that a renewal of the fee is due in January each year.
I will pay an annual fee of:
GBP 5.- (Student)
GBP 10.- (Junior Doctor)
GBP 15.- (Full Member)
Qualifications
Position held:
Professional Qualifications:
Languages:
fluent
fair
slight
none
Knowledge of German
Knowledge of English
Optional
I know AGMS from:
Friends
Poster/Flyers (where?)
Internet
Papers/Ads (which?)
Others (please specify)
Comments or questions: