Membership and Journal Subscription Form:

May 2008 - April 2009

Section 1: Contact Details (Please write legibly. All details will remain confidential.)
Title: Initials: Surname:
Address:

Tel: Fax: E-mail address (required):

Section 2: Current Fees (Please circle one box)
Type of membershipMembership Only* Membership + subscription to the PAPER J. Mol. Graph. & Mod. Vol. 27 Subscription to the PAPER J. Mol. Graph. & Mod. Vol. 27 for existing members#
Full Membership £ 20 £ 62 £ 42
Student Membership £ 10 £ 40 £ 30

* Subsidised subscription to the electronic J. Mol. Graph. & Mod. is available to members on request.
# Does not refer to members from previous years, only those who have registered as non-members for MGMS meetings held between May 2008 and April 2009 or attended the YMF2007 as students.
Section 3: Payment
Total Amount Paid (Membership + Subscriptions):
Method of Payment (please circle one): Switch / Delta / Visa / Mastercard / Cheque
Cheques must be made payable to "Molecular Graphics & Modelling Society". We do not accept American Express.
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 [] in stamped addressed envelope (which I enclose)

Do not send credit card details electronically.

Section 4: Signatures

Signature: ____________________________________ Date:_____________

For student membership, a supervisor's signature is also required: I hereby declare that the above is a student.

Supervisor's name _________________________ and signature: _________________________

Send to: Dr Jamie Platts, School of Chemistry, Cardiff University, Park Place, Cardiff, CF10 3AT, UK.