02.01.2013 Views

EPUAP Review 5/2 RIP - European Pressure Ulcer Advisory Panel

EPUAP Review 5/2 RIP - European Pressure Ulcer Advisory Panel

EPUAP Review 5/2 RIP - European Pressure Ulcer Advisory Panel

SHOW MORE
SHOW LESS

Create successful ePaper yourself

Turn your PDF publications into a flip-book with our unique Google optimized e-Paper software.

epuap Membership<br />

EUROPEAN PRESSURE ULCER ADVISORY PANEL<br />

Application Form, 2003–4<br />

MISSION STATEMENT<br />

The <strong>European</strong> <strong>Pressure</strong> <strong>Ulcer</strong> <strong>Advisory</strong> <strong>Panel</strong>’s objective is to provide the<br />

relief of persons suffering from, or at risk of pressure ulcers, in particular<br />

through research and the education of the public. The <strong>European</strong> <strong>Pressure</strong><br />

<strong>Ulcer</strong> <strong>Advisory</strong> <strong>Panel</strong> is a registered charity, number 1066856.<br />

MEMBERSHIP APPLICATION PLEASE PRINT CLEARLY<br />

Name: _________________ _______________________ __________________________ ______________________<br />

Title (Prof, Dr, etc) First name Last Name Degrees<br />

Full Postal Address: ___________________________________________________________________________________<br />

_____________________________________________________________________________________________________<br />

______________________________ Postcode: ______________________ Country: ___________________________<br />

Tel: ___________________________________________________________ Fax: _______________________________<br />

E-mail: ______________________________________________________________________________________________<br />

Main fields of interest: _________________________________________________________________________________<br />

_____________________________________________________________________________________________________<br />

_____________________________________________________________________________________________________<br />

Membership fee: £30 per year (September – September)<br />

Which includes Certificate of Membership plus the <strong>EPUAP</strong> <strong>Review</strong><br />

Cheques should be made payable, in British Pounds drawn on a UK Bank, to:<br />

<strong>EPUAP</strong> Registered Charity 1066856<br />

And application forms should be returned to:<br />

<strong>EPUAP</strong> Office, Wound Healing Unit<br />

Department of Dermatology, Churchill Hospital<br />

Old Road, Headington, Oxford<br />

OX3 7LJ, UK<br />

Fax: +44 (0)1865 228233<br />

Arrangements can be made for payment by Access/Mastercard/Visa credit cards<br />

(There is a £2 service charge added for this facility)<br />

a) Credit card type: Access/Mastercard/Visa (Please delete as appropriate) b) Amount to be debited: £32<br />

c) Credit card number: ______________________________________ d) Expiry date of credit card: ______ /______<br />

e) Exact name and initials on credit card: _______________________________________________________________<br />

f) Address to which credit card statements are sent: _______________________________________________________<br />

_____________________________________________________________________________________________________<br />

_____________________________________________________________________________________________________<br />

g) Signature to authorise debit of annual subscription: ____________________________________________________<br />

Volume 5, Number 2, 2003 75

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!