Membership Form

Membership Form

Also available as a PDF or Word document

Contact Details

Please write legibly. All details will remain confidential.

Title: Initials:
Tel: Fax:
E-mail Address (required):

Current Fees

Please circle one box:

Type of membership Fee
Full Membership £ 30
Retired / Career Break / Unemployed £ 15
Student Membership £ 15


It is possible to pay by cheque, credit/debit card, internet transfer or by standing order; the MGMS would like to encourage you to set up a standing order payment as this is the preferred method.

By Card:
Please circle card type:  Switch / Delta / Visa / Mastercard
Sorry, we do not accept American Express.

Payment Methods

Tick box that applies:

By Standing Order / Internet Banking
The Membership Secretary will email you with the MGMS bank account details on receipt of your completed form.
By Cheque
Please make cheques payable to Molecular Graphics & Modelling Society

Card Details

(Please send card details by recorded delivery or courier. DO NOT send card details by normal mail, email, or fax)

Card Number:

(16 digits for Visa/Delta/Mastercard, 18 for Switch)
Security Code:

(Last 3 digits on signature bar)
Expiry Date:

Issue Number:

(Switch only)
Card billing address:
If receipt required, tick box:
Please return by email [__] or post [__]  (enclose a stamped, addressed envelope).


Signature: Date:

For student membership, a supervisor’s signature is also required:

I hereby declare that the above is a student.


Send to:

Dr Gian Marco Ghiandoni
MGMS Membership Secretary
Academy House, 136 Hills Road