Application for Affiliate Membership

Name of organisation:

Postal address of organisation:

Country in which organisation is based:

Number of current members of organisation:

Title of individual applying on behalf of the organisation (Mrs, Ms, Miss, Mr, Dr, Professor):

First name/s:

Last name:

Position of the individual in the organisation:

Email address:

Confirm email address:

Contact telephone number:

Payment type:

After submitting this form you will be directed to the payment screen. Your membership will not be confirmed until payment is received.