BUG Membership Application Form

Membership Application

I wish to apply for the following category of membership of the British Uro-oncology Group (please select appropriate category):
Membership Type*
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FULL MEMBER: Consultant Clinical or Medical Oncologist
£100



FULL MEMBER: SAS doctor in urological oncology
£100



ASSOCIATE MEMBER: Resident doctor in training
£30
Upon submission of this form, membership payment can be made via online bank transfer, stating your surname as the reference:

Sort code: 30 99 71

Account number: 027 026 78

Name of account: The British Uro-Oncology Group

Alternatively, you can phone the secretariat on 0203725 5840 to pay via Credit Card once your form has been submitted.
Name*

TitleFirst NameSurname
Qualifications*
Hospital/clinic*
Address*

Street Address

Street Address Line 2

CityCounty

PostcodeCountry
Use the address above.I want to specify a different correspondence address.
Correspondence Address

Street Address

Street Address Line 2

CityCounty

Postcode
Telephone*
E-mail*
Current appointment*
GMC Number*
I give permission for my details to be available to other members
Research Interests
Your membership application will be approved by the Executive Committee. See the BUG Membership Rules document for further details.

BUG Membership Rules
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