Please write legibly. All details will remain confidential.
|E-mail Address (required):|
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.
Please circle card type: Switch / Delta / Visa / Mastercard
Sorry, we do not accept American Express.
|By Standing Order / Internet Banking
The Membership Secretary will email you with the MGMS bank account details on receipt of your completed form.
Please make cheques payable to Molecular Graphics & Modelling Society
(16 digits for Visa/Delta/Mastercard, 18 for Switch)
(Last 3 digits on signature bar)
|Card billing address:|
|If receipt required, tick box:
Please return by email [__] or post [__] (enclose a stamped, addressed envelope).
For student membership, a supervisor’s signature is also required:
I hereby declare that the above is a student.
Dr Gian Marco Ghiandoni MGMS Membership Secretary AstraZeneca Academy House, 136 Hills Road Cambridge CB2 8PA UK