The Society of Dairy Technology: Membership Application Form

Personal Details: Title:
Surname:
Forename(s):
Address:
Town / City:
County:
Postcode:
Home Tel:
Fax:
Home Email:
Date of Birth:
Nationality:

Grade of Membership: Full:
Retired:
Student:

Employment Information: Name of Employer:
Employer's Address:
Town / City:
County:
Postcode:
Employer's Main Business:
Position in Company:
Work Tel:
Work Fax:
Work Email:
Professional Qualifications/Membership of Professional Bodies:

Contact Preference:

Please specify which address you would prefer us to use for any correspondance by selecting sone of the options below.

Home:
Work:

Confirmation:

Declaration:

I hereby apply for membership of the Society of Dairy Technology, a company limited by guarantee. I undertake, if elected, to abide by the Rules of the Society amd its Memorandum and Articles of Association. I also undetake to pay the sum of £1 in the event of the dissolution of the company. In the context of the Data Protection Act, I agree to my above details being published in the Society's Directory of Members and for all other relevant purposes at the Society's discretion.

Signature:
Work Email:

*to be signed by two members of the Society who know the applicant personally

Signature:
Work Email:
Signature:
Work Email:

Please return the completed Application and Direct Debit Instruction form to: The Society of Dairy Technology, PO Box 12, Appleby in Westmorland, Cumbria CA16 6YJ, UK